HomeMy WebLinkAboutTR-1336Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO .... ~.~ ........... DATE: ...O.¢.-~.~...g~.L...Z9?8
ISSUED TO ................... g .i.. ¢.~.~.... ~.e..e. ~.~ ..................................................................
Pursuant fo +he provisions of Chapter 615 o{ the Laws of
+he State of New York, 1893; and Chapter 404 of the Laws of ~he
State of New York 1952; and the Soufhold Town. Ordinance en-
titled "REGU~TING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, ~RAVEL OR OTHER MATERIALS FROM
W
LANDS UNDER TOWN ATERS; and in accordance wlfh the
Resolution of The Board adopted afa meeting held on ....~e~.~.._5..,
19..~...., and ~n con~deraflon of the sum of $...~.~:.~ ....... pa~d by
........................................... .....................................................
Terms and Conditions lis+ed on the reverse side hereof,
of Soufhold Town Trustees aufhorlzes and permlfs the foilowlng:
~ ~lli~gs oEE ~l~e ~o~e~y ~ ~ocAey C~eeA
all in accordance with the detailed specifications as presented in
· the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes ifs Corporate Seal to be affixed, and these presents fo
be subscribed by a maiorlty of the said Board as of this daf, e.
......
BOARD OF TOWN TRUSTEES
Town Of Southold
Main Road
Southold, New York 11971
APPLICATION FOR FIXED and/or FLOATING DOCKS
1. Applicant's name and address: ...R..I..C..H..A..R..D....G.,.R,.E..E..N..E. ......................................................................
(no #) Glenn Road, Southold, Fl. Y. 11971
2. Contractor's name and address: riot selected as yet
3. Briefly explain the purpose of this application: ,..C..0.,n..s..t..r..u..c..t.,i..0..n,...0.,f....f..1..o..a..t..i.~..~ ............
approximately 4' x 12' with 5 -"7-~'~Ti~gS~ w~ ~'~O~ ~aJ/~
After issuance of a Permit, I expect to: (mark by an )O
(a) Commence work -- AT ONCE ............ ; ASAP .......X.....; UNKNOWN .............
(b) Complete work in -- 1 DAY ............ ; I MO ...... X ..... ; I YR ............. ; FUrFURE .............
Secure the correct Area Map from the Secretary of this Board, and by using an, X WITHIN
A CIRCLE indicate as closely as possible the location of this dock, On the reverse side of this
map, provide a SCALE DRAWING which will show Ordinary High Water Mark, the shape
and size of the dock and an,/ supplemental pilings which are needed to hold a floating dock
or tie-up a boat. Give all dimensions necessary to determine the area of the dock surface
which extends offshore from the O. H. W. M.
6. Will any por'rion of this construction extend offshore into 'Town Waters beyond an, imaginary
line or boundary formed by other similar structures along the area's shoreline? YES or(~
If it does extend beyond this so-called dock line indicate by how far, approximately,. ......... ft.
Provide the following docu,ments:
(a) A Licensed Engineer's Survey of the property involved.
(b) A copy of t'he Contractor's Plans and Specifications., to f0ll0w.
8. Will this cons~'ruction require the Filling of any land ,offshore of the Ordinarx~l~Ligh Water
Mark or the Dredging of any material from Town Lands under water? YES or~_NO.])lf it does,
Form A/4 (Application for Dredging/Filling) must be completed and attached a~-'~ort of this
application.
In requesting approval of this application, I submit that: the information presented herein
is true and correct to the best of my knowledge and belief; I am the person accountable for
the performance of the work in accordance with the plans and specifications attached; I have;
read or am familiar with the provisions of any Southold Town Ordinance pertinent to the work
involved; and further, I intend to adhere to and abide by the Terms' and Conditions of the
Permit, when and if issued to me.
Accepted b,/: Dated: July 1978
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