HomeMy WebLinkAboutTR-148 TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
PERi'IT NO ...... /....~.....~..
Pursuant to the provisions of Chapter 615 of the Laws of ]893 of the State of
New York and Chapter 404 of the Laws of 1952 of the State of New York ahd [6 accordance
with the resolution of the Board of Trustees of the Town of SouthOld adopted at a meeting
of said Board on.....~.~.~.~....~,.D..*....~.~..~. .............................. and in consideration of the sum of
$...~.,.~.0.., lawful money of the United States, paid by...~.,...~D...T~.~t~%S[e, e4~ ........
residing at .......... .O.~.~!~.~.,~..~J[~,~.~ie,~tlC~,...~,~, .......................... , New York,
the said Board of Trustees of the Town of Southold, Suffolk County, New York, hereby
authoFizes and permits said....~.,...~J~E~..~a~,~.~,e~ ............................................. to
~l~uc~, ~ ~k, all ~ acc~ce ~i~ ~e ap~li~i~
The said ...... .~.~..:~'.~.~.~..~g~ .................. , as F:rt of 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 damages, claims for damages or suitsthat may arise or
occur directly or indirectly as o result of any operation carried 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 ~ 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 and conditions:
That there shall be no unreasonable interference with navigation as a result of the
work herein authorized.
That there shall be no interference with the right of the public to pass and repass
along that portion of the beach between Iow and high water mark.
That the work shall be subject to the supervision and approval of the said Board of
Trustees or its agents.
IN WITNESS WHEREOF, the said Board of Trustees of the Town of Southold has
caused its corporate seal to be hereunto affixed and these presents to be subscribed by
a majority of the said Board of Trustees, the day and yegr above written.
seal ~ ....~~~.,~.--,~.....( L. S.)
(L
S.)
STATE OF NEW YORK )
SS:
COUNTY OF SUFFOLK )
ON THIS....2Et~, ...... day of...... ......... -~l~t. ................................ 19.~],.., before me
personally appeared ~n~ Dea~ OE ~ort, ~ ~ ~. OE
OE ~i~. ~ ~ ~v~ ~1~. of SOu~ol~plJ personally known
~o me, who, being bV me duly sworn, severally said that~ey each resided in the ~own
o~ ~uthold. County of Suffolk, State of New York, and were me.ers of the Board o~
Trustees of said Town of S~th01d and constituted a maiori~ of the same; that they
~new the corporate seal of ~id Town of Southold; that the seal affixed to the foregoing
instrument was such corporate seal; that it was so affixed thereunto b~ order of the
~oard of Trustees of said Town of Southold and thor each one signed his name thereto as
a Trustee and by like order.
..............
/UDffH T, BOKE~
Town OF OUTHOLD
BOARD OF TOWN TRUSTEES
TOWN CEERK'S OFFICE.
SOUTHOLD, N. Y.
Disapproved a/c ............................................... ~ ..................................................................................................................................................................................
~ .... 'chairman, Board of Trustees
It, S TF~LVCT~O.I~ S
A. This application to be completely filled in by typev~'iter ur in ink add submitted to the Tov~ Trustees ~ dup-
~oa,ge.
B. ~l~t plan showing location, of lo~ and buildings o~ premises, rela$io~ to. ~djo~ng pre~ses, public: s~ree,ts,
p~ks, e~o., ~ad Wing dega~ed deec~p~ion of proposed layo,u~ c.f project must be, ~a,~ on dia~am which is p~ of
~h~ app~cm~io,n.
C. The work covered by this application may no~ be commenced before the issuance, of a permit.
D: Upon approv~ of tl~s a,pp~ca.tion, Town Trusteee w~ issue ~ permit to applicant. ~uch perm~ sha~ be kep%
on the premises ~nd available for inspeci/on at all times.
E. AppEcaat sha~! noilly the Boazd of Trustees npon comp~eiion of lhe work covered by pemii.
APPL~0ATION IM HE~EB~ ~IADE lo the BoaJd of TEstees of the Town of Soaihold, Muffolk 0:o~miy, ~ew York,
for ~he issua.ace of m pe~ii p~suant ~o the laws, Ordinances ~d regMaiions governinf c.onstEciion o.f: docks,
piers, bu~ea,ds, jettys ~d ~ed~f in; under, and over the ~ters of To~ of Mouthold. The mp.pEcami a~re.es
to comply wilh ~ app~o~ble~ laws, erdinances, reg~lmtions an~ conditions specLfied by said lrusiees, amd to hold
lhe Town of Southold, a~d a~ Tov~ o~ciMs free from liability and damag'es Gf any ~d.
Street
Ad.ess
Creek, Bay or Harbor Fronting Proper~y .............................................................................................................................................................................................................
~ize of Proposed Work: Length ....~.~......~. .......... Wi~h ................................. Heighth Above High Water ................................
~se .... In T~de ...~ ........................ ~ Yards to Be ExcavaSed ................................. ~/~
Depth Below Low Water ........ ~ ........... Average ' -- ~
Width of 0areal, Oreek or Ba~ Pronlinf Property .......... ~..[ ....................... Depth at Low ~de ._..~.~. .......................................
Is This For Priva,ie or Business Use? .......~e..*[~.~ ............................ Area Zo,~ ...........................................................................
0omplete ploi plam ~o be dravm on reverse side of t~s applicalion.
STATE OF 1T~IW YORK)
)S.S.
~._,... / . ................................... being dtfly sworn, deposes and says tha~ he is the a,pplicant: for the above de-
scribed permit, aad tha~ a~ s~a~e~ents contained herein ~e true $o the beet of his kn,owle,dge
work ~11 be done in the m~ner se~ fo~h in the appHc,atio~, aad as approved by the Board of Truste;e~ o~ the To~
of ~o~thold, and the app~c:ant agrees ~ hold the To~ of SGuthold a~d said trns~ees h~ess ~ free from ~y
and aE damages and cla~s aris~g under' or By virtue ~f s~d petit.
(appHcant)
....... .........
19.~..~...
Sworn