HomeMy WebLinkAboutTR-74 Pursuant to the provisions of Chapter 6]5 of the Laws of 1893 of the State of
New York and Chapter 404 of'the Lows of 1952 of the State of New York end in accordance
with the resolution o¢ the Board of Trustees o¢ the ~own of Soufhold ~dopted ~t ~ meeting
of said Board on ....~.~...~Z¢....~.~ .......................... and in consideration of the sum of
$ ...... ~.~..~.~ ...............bwfu! money of the United States, paid by .....~.~.~...~.%..~.~.~
th'8"~618 Botrd o; Trustees of the Town 6f SoutH0qd, Surfak County, ~ew ~ork r b
euthonze~ and permits sa~a ...................... ~ ................. ~:..~ ............................................. to
e~ec'~-.~ ~icck zn front of hi~
all in accordance ~ith the applic~Qa~:~bm~Dted
Tk~ .4 , ~$oz'q~ ~. Lagergren as
F ].- ~,,=.,~¢ _~ ;~;:~.,;,~ ............................................................ , part of the consideration
for the issuance of this permit does hereby release the said Board of Trustees and the
Town of '2outRold f~om ~ny ~nd ~11 d~m~ges cl~ms for d~me&es or suits that
occur d~¢gct¢y o[ in¢irectly ~-e resu ~.~f ~ny ope¢~ o~ '6e~r~ed on un,er un8 ~su~nt'td
p~m~t; ~nd will 8f his 5wn expense, defenU eny ~nd ~11 su~ts which m~y be brought by
oarbes as a result Of any operatfon carrfed on pursuant to or in accordance with the terms of
¢i~'B0drd o~ T~es' 'and 'tho'%awn' or-'So~thol~
FOI~I~ NO. 1
TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLD, N, Y.
Examined ....~'~../..~Z 19..4~[~. Application No.
Disapproved
............ ~ ......... chs~irman, Board o£ Trustees
APPLICATION FOR PERMIT
A. ~uts ~gHc~t~o~ ~o 5e CO~gZ~rteZ~ Q~e& ~ ~ ~e~J~e~ O: ~ ~ ~ s~b~J~:e&
~cate.
B. Plot plan showing locaiion of lot a~ b-~ngs o~ presses, relation to a~o~ng presses, public
p~s, etc., a~d g~ng detailed description o~ p~opcsed layout of project must be ~awn o~ ~a~am w~ch is pa~ of
this apphc~on.
C. The work covered by ~Ms appEcation may not be commenced before the issuance of a petit.
D. Upon approval of this ap~hcaticn, Town Trustees wiR issue a pe~t to appEcant. Such pe~m~ sha~ be kept
on the praises and ava~able ~o~ inspection at aR times.
E. App}ics~nt shaR notify the Boaed of Trustees upon. completion of the work covered by per~t.
~PLIOATION !~ HEREBY EADE to the Board of T~tees of the Town of Southold, S~fo~ CoWry, New York,
for the issuance of a petit p~suant to the laws, Ordnances and regulations governing construciion of: docks,
piers, bu~eads, iettys and dre,daing in; ~nder, and_ over the walers of Town of Southold. The applicaat agrees
to comp!y ~h aa applicable laws, ordnances, re2~lations aa~ con~tions specified by s~d trustees, an~ ~o hold
the Town of Sonthold, and aE To~ officisis free from Eab~$y and damages of any ~d.
~ ~ ....................................................................................................................................................
Name of o~er of premises ..................... ~E..~:.~..~...~
Street Address of Prope~t,y ..................... ~.~..~._~
Home address If Other Than Location .._..~_~..~ ~...~$._~,~, ..............................................................................
Creek, Bay or Harbor Fronting Property ...~..~
Permit Requested To: ............. ~.~ ................................................................................................................................................ : ...................................................
Size of Proposed Work: Length~..~.~ Width ...~..~ .................. Heighth Above High Water ~..~
Depth Below Low Water .....~ ................ Average Rise !n Tide 2~.~ ........... Yards to Be ~cavated ._.~ ..................
Width of Can~, Creek or Bay Fronimg Prope~y~..~:.~. Depth at Low ~de .~._~..~_~...~a..~l
Is This For P~vate or Bus,ess Use? ....~%~ .......................................... Area Zo~ng ...........................................................................
Complete plot plan ~o be drawn on reverse side of this apphcation.
STATE OF NEW YORK)
scrioed~-- ~;permit, a~/l'that ~11 statements contained herein are true to the best of his ~owledge ~d be~ef; that ~he
work wi~ be done in the manner set forih in the apphca~ion and as approved by ~he Bo~d of Trustees of the
of Southold, ~d the app~cant agrees lc hold the Town of So~thold and said trustees h~mless and free from,~y
p e rmit. ' ~~~~~
and a~ dam~ge~ ~d claims a~ising under or by vi~ue of s~d
- - ~ ~ ~ /~ Notary ~ub~'c, S~ate o~ New
~~~ Ne, 03-343~850 Qualified i. 9roax ~
/ Car ed w~ N Y CounW