HomeMy WebLinkAboutTR-428 TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
PERAAIT NO ....................
Pursuant to the provisions of Chapter 6t5 of the Laws of 1893 of the State of
New York and Chapter 404 of the Laws of 1952 of the State of New York a/ad in accordance
with the resolution of the Board of Trustees of the Town of Southold adopted at a meeting
of said Board on.....~,~ll......4,...~c~f~ ...................... , and in consideration of the sum of
$...~.~.,.~.,~., lawful money of the United States, paid by.../~.~.~,...~...~,...;I.~,. ...........
John ~ ~la~, Treas.
residing at ,~S~.,P.O/z~t~..~C:~:~t,...L~I, ................................... , New York,
authorizes and permits said.....~..~....~.~ ................................................ to
~ Y~k, f~ ~rivate use , all ~ acc~ce ~i%h ~e
The said ...~ho~...~n~..!n~ ............................. , as part of the consideration
for the issuance of this permit does hereby release the said Board of Trustees and the
Town of Southold from any and all damages, claims for damages or suits that may arise or
occur directly or indirectly as a result of any operation carried on under and pursuant to this
permit, and will at his own expense, defend any rand all suits which may be brought by third
parties as a result of any operation carried on pursuant to or in accordance withthe terms of
this permit, and assume full liability with respect thereto to the complete exclusion of
said Board of Trustees and the Town of Southold.
THIS PERMIT is subject to the following terms and conditions:
l. That there shall be no unreasonable interference with navigation as cz result of the
work herein outhorized.
2. That there shall be no interference with the right of the public to pass and repass
along that portion of the beach between low a'nd high water mark.
3. That the work sha~l be subject to the supervision and approval of the said Board of
Trustees or its agents.
IN WITNESS WHEREOF, the said Board of Trustees of the Town of Southold has
caused its corporate seal to be hereunto affixed and these presents to be subscribed by
a majority of the said Board of Trustees, the day and year above written.
seal ...... ..~..~.~~(L S.)
-: ,.~; ...... (L. S.)
................................................. ; .......... (L. S.)
STATE OF NEW YORK )
SS:
COUNTY OF SUFFOLK )
ON THIS........~...~.. ....... day of ............ .~...a.~. ...................................... 19....6..~.., before me
personally appeared A~V~ ~, ~th~ F~ Da~r~ J~ ~,
all personally known
to me, who, being by me duly sworn, severally said that they each resided in the Town
af Soathold, County of Suffolk, State of New York, and were members of the Board of
Trustees of said Town of Southold and constituted a majority of the same; that they
knew the corporate seal of said Town of Sauthotd; that the seal affixed to the foregoing
instrument was such corporate seal; that it was so affixed thereunto by order of the
Board of Trustees of said Town of Southo~d and that each one signed his name thereta as
a Trustee and by like order.
Fil~
FORM 1~0. I
TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Application No ..................
Examined ............................. 19 ......
r isapproved .......... ........ .................... f .......................
APPLICATION FOR PE IT
INSTRUCTIONS
A. This applicatio~ to be completely filled in by typewriter or in ink and submitted to the Town Trustees in dup-
licate.
B Plot plan showing location of lot and buildings on premises, relation to adjoining premises, public streets,
parks, etc., and giving detailed description of proposed layout of project must be drawn on diagram which is part
of this application.
C. The work covered by this application may not be commenced before the issuance of a permit.
D. Upon approval of this application. Town Trustees will issue a permit m applicant. Such permit shall be kept
on the premises and available [or inspection ar all times.
E. Applicant shall notify the Board of Trustees upon completion of the work covered by permit.
APPLICATION IS HEREBY MADE to the Board of Trustees of the Town of Southold, Suffolk County, New
York, for the issuance of a permit pursuant to the laws, Ordinances and regulations governing construction of: docks,
piers, bulkheads, jettys and dredging in, under, and over the waters of Town of Sonthold. The applicant agrees
to comply with ali applicable laws. ordinances, regulations and couditions specified by said trustees, and to hold
the To~vn of Southo!d, and all Town officials free from liability and damages of any kind.
Name of owner of premises . .H¢~_,t~', [~V{~. 2~: .............................................................
Street Address of Property ...~.'q.t.~.~. ~.99.r~.'.q. ~gX..~..~.~.~ .IF.'.~.~fi.a..u' .P.q$.nzt.~' . .C.u.~.e~.o§.q~.2..E....~: ..............
Home address If Other Than Location ZL~ Glens±de Road~ Sou~2n 0~ange~ N.., ~.
Creek, Bay or Harbor FronHng Property ....W.~...g.~.w.~..+~.., ~.o. i3.d ......... - .......... : ...............................
Permit Requested To: ...B.u.~..ki.~.e.a.d..pr. qp...eT.By' .~9.~..t~.z'.i.vf4..~.~..~.s.e, ...............................................
Size o~ Proposed Work: LengCh ......... .2.~07. ....\%qdth .............. Heighth Above High Water .... ~.',.~l.~ .....
Depth Below Low Water ......... bfi. .....Average Rise In Tide ........ 2,.~[ .Yards to Be Excavated ..............
Width of Canal. Creek or Bay Fronting Property.a.~- .h~.a.d..o.~..q~.k...Depth ar Low Tide . ~..~}~9..{~. ...........
~... f. ~: ...........
Is This For Private or Business Use? . .P.~..~.~..~..o. ........................ Area Zoning .
Complete plot plan to be drawn on reverse side of this application.
STATE OF NEW YORK )
) S.S.
COUNTY OF S~3FFOLK )
.~0,r-i~ .A.. ~,~>~tK ............. being duly sworn deposes and says that he is the applicant for the above de~
scribed permit, and that al1 statements contained herein are trne to the best of his knowledge and belief; that the
work will be done in the manner set forth in the application and as approved by the Board of Trustees of the Town
of Southold, and the applicant agrees to hold the Town of Southold and said tr_ug, tees harmless and~ree from~qt~y
and all damages and claims ar~smg under or by ¥~rtne of satd permm~-,
......
Sworn to before me this ..... ~ ! ...... day of..F:a~¢h .......... 19~"....
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