HomeMy WebLinkAboutTR-E 111-9-9 GFBoard Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO.
ISSUED TO
Pursuant fo the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 404 of fha Laws of the
State of New York 1952; and the Southold Town Ordinance en-
titled "REC=ULATINC= AND THE PLACINC~ OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, SRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance with the
Resolution of The Board adopted at e meeting held on ]~--~'~ ~--
19 , and in consldi~ratlon of the sum of $ z~,'e:~r~:)-~ paid by
of .................................................... N. Y. end subject to the
Terms and Cond[tlons listed on the reverse side hereof,
of Southold Town Trus'~ees authorizes and permits the 'Following:
all in accordance wi~h the detailed specifications ss pre~nfed in
the originating appliceflon.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to
be subscribed by a maiority of the said Board as of this dat.e.
Trustees
John L.
John B. Tuthill
Telephone (516) 765~1892
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
· Town .Hal~: 53095 Main Road
P.0,. Box 1179
Sou~h01d;'~w York 11971
~ax ~i6) 765-i823
Tetepho~'(5 i 6) 765-1800
~RANDFAT~ff~ APPLI'EATION
Nam~ of Applicant:
Mailing address:
Address of Property: ~705 ~/~/%.~o
Tax Map Number: 1000- ///- ~ --9
Prior owner if known: G,.
Approx.yr.of
construct:
Diagram of
included with this application:
existing structures,'including all dimensions,
must be
Indicate on attached map: Location, ie; re~erence point, telephone
pole number, adjacent property owners, etc.
Please note, there is ~ one time fee of $5~.00 for filing this
application.
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