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HomeMy WebLinkAboutTR-155 TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES PE ,T No ....... Pursuant to the provisions of Chapter 615 of the laws of t893 of the State of New York and Chapter 404 of the taws of 1952 of the State of New York and i~ accordance with the resolution of the Board of Trustees of the Town of Southold adopted at a meeting of said Board on.......A..~.~.~..?...~.,~.....t....9~,.~. ................... , and in consideration of the sum of $,....~.?...,..0..?., lawful money of the United States, paid by.....J...O,.h..~....?..?..:~,.i-t'~..~.,D ......... residing at ......... ~.?.~...~...~.t....S..O.~.O..1..~..!.,.,L..,*~.: ................................. , New York, the said Board of Trustees of the Town of Southotd, Suffolk County, New York, hereby authorizes and permits said ............ ..J.~.~.....F..,...~..~..1.~..:....,~..%.D..~. .................................... to e~e~ a ~o~m jet~p o~ ~he ~or~J~eas~ ~orne~ of ~is ~ro~er~y The said ........ .J.~.~....~.t...~.[...l.~.;....~?~.D.~ ................. , as part ef the consideration for the issuance of this permit does hereby release the said Board of Trustees and the Town of Southold from any and all damage s, claims for damages or suits that may arise or occur directly or indirectly as a result of any operation :arried 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 to or in accordance with the terms of this permit, and assume full liability with respect thereto to the complete exclusion of said Board of Trustees and the Town of Southold. THIS PERMIT is subject to the following terms ond conditions: ]. Thor there shall be no unreosonoble interference with nevigation os a result of the work herein outhorized. :2. Thor there sholl be no interference with the right of the public to p~ss ond reDoss olong thor portion of the beoch between Iow end high water mark. 3. Thor the work sholl be subject to the supervision end epprovol of the soid Board of Trustees or its ogents. IN WITNESS WHEREOF, the said Board of Trustees of the Town of Southold has caused its corporate seal to be hereunto af fixed and these presents to be subscribed by a majority of the said Board of Trustees, the day and year above writ-ten. seal ~~rz~,~/...~r,~,~.. ( L S.) .............. STATE OF NEW YORK ) SS: COUNTY OF SUFFOLK ON THIS....2..~.,..~.~ ........ day of ......... .~...~.~.~.~- ............................... ]9..C~.].., before me personally opiated ~ ~, O~ ~~ ~ ~i~ ~il~, O~ ~el, ~ ~ ~ ~Ol~i~, Of ~I~,~ all personally ~own to me, who, being by me duly sworn, severally said that they each resided in the Town of Southold, Coun~ of Suffolk, State of New York, and were members 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 affixed to the foregoing instrument was such cor~rate seal; that it was so affixed thereunto by order of the Board of Trustees of said Town of Soathold and that each one signed his name thereto Not~ Public ]~DIT~ L C0mm~ssi~ ~Jres ~rch FOF~I ~0. 1 TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined... ~(~... ~..~ ..... 19..~,/.. Application No .................. Approved .....~./.~ .~..¢fl>~.~..-~':.. ....... Permit ik'o ........ ./..~..~.~. .............. /, Disapproved a/c .................................................... [ ...................................... ........... ~..~/-'~/'~/.~.~ .......... Chairman, Board of Trustees APPUCAT~ON 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 to adjoining premises, public streets, parks, etc., and giving detailed description of proposed lay6ut 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 ail 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 o£: docks, piers, bulkheads, jettys and dredging in, under, and over the waters o£ Town o£ Southold. The applicant agrees to comply with all applicable laws, ordinances, regulations and conditions specified by said trustees, and to hold the Town of Southo!d, and all Town officials free from liability and dar~ages of any kind. ame of owner of premises ......... ........................ Street Address of Property ...... Home address If Other Than Location ........ ~qW~F. .~...~y~.~ .............. ... ............................ .............. Permit Requested To: .... ~.7. ~~.~'~' ~~~ ~~.~... Size of Proposed Work: Len~h..~.~. ........... .Width. ~'.. ........ Heighth Above ~igh Water..~. ......... Depth Below Low Water..~'~.~. ..... Average ~se ................ Yards to Be Excavated .............. Width of Canal, Creek or Bay Fronting Pr~erty..~.: ........... Depth at Low Tide .~.5~ ............. Zs This For Private or Business Use? .. ............... Area Zoning~/~~ ........ Complete plot plan to be draw~ on reverse side of this application. STATE OF NEW YORK ) )S.S. COUNTY OF~ ) . ~____~...,.__.;ff~.~~/~-~d~. being duly sworn deposes and says that he is the ~pplicant for the above deb sc(C/bed permit, and th~'t all statements contaiaed herein are true to the best of hls 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 from an7 and ali damages and claims arising under by virtue