HomeMy WebLinkAboutTR-145 TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
PER IT ........
Pursuant to the provisions of' Chapter 615 Of the Laws of 1893 of, the. State of
New York and Chapter 404 of the Laws of 1952 of the: Stat~ of New York and i~ accordance
w~th the resolution of the Board of Trustees of the:Town' of Soufhold adopted~at ~ meeting
of said Board' on ......... ~.,..:~..z...~.~.~ ........... , and in'consideration of the sum of
$.....~.~,.~ law~ ~ mo~ey of the United States, paid By...~,..~,~...~6~ ..............
~esiding at .......... ~..~,..~~x...~.~, ............................... , New York,
the said B~ard of T~ust~s~of the T~n of Southold, Suffolk ~un~, New York) hereby
authorizes and permits said ........... ~..~..~ ........................................... to
The said ......... ~...~..:...~..~.~. ..................... , es part of the consideration
for the issuance of this permit does hereby release the said Board of Trustees and the
Town of Soathold from any and all damages, claims for darnages or suits that rnay arise or
occur directly or indirectly os a result of any operation carried on under and pursuant to this
permit, and Will-at' his own-expense, defend any and all suits which may be brought by third
parties as a result of any operation carried on pursuant toot in accordance with the terms of
this permit, and assume fall liability with respect thereto to the complete exclusion of
said Board of T~ustees and the Town of Southotd.
THIS PERMIT is subject to the following terms and conditions:
]. That there shall be no unreasonable interference with navigation as <3 result Of the
work herein authorized.
2. That there shall be no interference with the right of the public to pass and repass
along that portion of the beach between Iow and high water mark,
3. That the work shall 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 <:nd 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.)
STATE OF NEW YORK )
SS:
COUNTY OF SUFFOLK )
personally appea~red E~ISI~S~
to me, Who, being ~y me duly sworn, severally said that they each resided in the Town
of Soath01E, Coun~ .of Suffolk, State of New York, and were members of the ~ard of
Trustees of ,said ,Town of Southold and constituted a majori~ of the same; ,,that they
knew the corporate seal of said Town of Southold, that the seal at'xed to the;feregoing
in~r~ment w~s such corporate seal; that it w~s so affixed 'thereunto by order of the
Board~of Trustees ~f sai~ Town of Southald and that each one signed his name t~ereto as
~ Trbstee and by like order.
~DJTH T. BOKEN
~o. 52-0344963. Suffolk Co~
TOWN OF $OUTHOLD
BOARD OF TOWN TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLB. N, Y.
p. proved ......... ~-~.~...~ ~ ............................. Permit No. ............... .-~;..! ....................................................
Disapproved ~/c ................................
............... :~_ - ............ ~.~ ................ chsirman, Board of ~tees
/ APPLICATIO~N FOR PERMIT
INSTP~UCT[0NS
A. This appIicaticn to be completely filled in by typewriter or in ink a~ut submitted to the Town TYustees in dup-
licate.
B. Plot plan showing' location of lot and buildings on premises, relation to adjoiniug premises, public streets,
parks, etc., and giving detailed descr~_ption of preposed layout of preject must be drawn ou diagram which is part of
th/s applico~tion
C. The work covered by this application may not be commenced before the issuanee of a permit.
D. Upon approval of th~s appIicatien, Town Trustees wLtl ~ssue a permit to applicant. Such permi~ shall be kept
on the premises and available for ~nspectien at all ~mes.
'E,. App!lca~t shah notify the Bo~rd of Trustees upoa completion of the work cove~ed by permit.
APPLICATION IS HERE~Y MADE to the Boa~d of Trustees of the Town of So~thold, Suffolk Cotmty, New York,
for the issuance of a petit p~susn% to the l~ws, Ordnances and regulations goverui~ const~c~ion of: docks,
piers, bu~eads, jettys aa~ ~eds~g in; under, a~d over the waters of Town of ~o~thold. ~e appScamt agrees
~o comply ~h aH a~plicable laws. er~aances, reg~ations an~ con~tions specified by said trustees, ~d ~o hold
the Town of Southc]d, ~ and damages of any ~d.
N~e of owner of premises _.:. ....
S~reet Address of Property _
Home address If Other
Creek, Bay or ~bor
Permit Requested To:
S~e of Propesed Widt~ Heighth Above ~h Water .~_~ ...........
Business Use~ '~ ~ ' ~ ~ ~ ....
Is T~s For PMvate or ...... ~.~ ......................... Area momng
Complete plot plan to be dra~ on reverse side of this application.
STATE OF NEW YORK)
)s.s.
COUNTY OF~..~ )
scribed permit, emd that all 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 Boar~ of Trustee,s of the Town
of Southold, a~d the applicant agrees to h~ld the Tovrn of Southold and said trustees harmless and free from
and all damages a~d claims arising under or by virtue of said permit.
Sworn to before me this ................. ~ ........ day of .......