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HomeMy WebLinkAboutHART, CHARLES J.t966 Dear X am returning your atton tc~e~er wit~ t~e $1.50 which ac~m%~anie~ the ap~li=a~iOno %~ery ~uly y~ars, FORM NO. I TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .............................. 19 ...... Application No .................. Approved .............. , ....... L ................. ' ..... t Permit No ............................. DisapproveO ................................ · .?i ...................... Board of Trnstees APPLICATION FOR PERMIT INSTRUCTIONS A. This application 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 ro 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 to applicant. Such permit shall be kept on the premises and available for inspection at 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 zo comply with all applicable laws. ordinances, regulations and conditions speci/ied by said trustees, and to hold the Town of Southotd, and all Town officials iree from liability and damages of any kind. Name of owner of premises...~.~.~..& .~[..~. ~..~:..~.*.~ ................................................... Street Address of Property..¢~.k~.. ~.~.,. ~.~ ........................................................ Hohe address If Other Than Location'..~.~.a~h ~'.a~ ~.*~e.G~ J~]¢~ ~j ..... [ Creek, Bay or ~arbor Fronting Proverty~. ~&.*~.~.t lil.a~}.~.,.j ~ ~,~..B~. ~aN~.~ ..... Permit Requested To: .~.~ ~ ~.¢~.~.~ ~ [[. g.q ~ ~ ..... ~.~,9 ~f ~ ................................ Size of Proposed Work: Length ..... (~,~ ...... Wide... ~e ..... ~eighth Above High Water,.~( ..... Depth Below Low Water· .~ ....... ~Average ~se In Tide...~.'. .... Yards to Be Excavated .... f..~:~ Is This For Private or Business Use? . ~.i gi~ ..................... Area Zoning ...,~ ...................... Complete plot plan to be drawn on reverse side of this application. STATE OF N,~W YORK ). )s.s. COUNTY OF ) .................... lng duly sworn deposes and says that he is the applicant for the above de- scribed permit, and that all statements contained herein are true 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 trustees harmless and free ~om any and all damages and claims arising under or by virtue of said permit. ............................ ~ ~- f (applicant) Sworn to before ~e this .... ~..}.~ay Of .... ~.~... 19[~,