HomeMy WebLinkAboutGUINAN, GEORGEYOUR ORIGINAL PER~qIT NUMBER
BOARD OF TOWN TRUSTEES
Town o£ Southold
3taln Road
Southold, ~New York 11971
APPLICATION FOR SPECIAL ICE DAMAGE PERMIT
INSTRUCTIONS: Fill out form below and return to above address. You
should have this application approved and returned to you within a week°
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1. Applicant's Name & Address.-.. ....................
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2 Contractor's I~ames & Address' '
Tel No
3% The purpose of this application: Redriving or replacing openwork
dock or openwork uier piling, and mooring piles, removal of damaged
piling, repair, resetting or replacement of floating docks, ramps,
or decking, all necessitated by ice and storm damage resulting during
-~886-~7 -'-Winter.
SPECIAL CO£NDITIONS
1. Mo dredging or filling is permitted.
2. Repairs to existing structures shall be limited to replacement of
timbers withoht change in design or dimension.
3. No repair or replacement of bulkheads ms permitted under this permit.
4. No freshwater or tidal wetlands are to be disturbed under any
circumstances.
.5. A yellow permit sign provided by this office shall be displayed on
the projecn at all times while under replacement.
6. Original permit numbers (3': high) muse be permantl~ displayed on
project.
..............................''''°''''''''''''(Tear off and re~urn)''''' .........................
I, certify that the work as authorized in
this permic has ~een completed and is now ready for your inspection.
Also, the permit number required on this projec= is clearly visible.
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