HomeMy WebLinkAboutTR-4189 GFBoard Of $outhold' Town Trustees
.SOUTHOLD, NEW YORK
PERMIT NO
DATE: ......6/2~/.9:~ .
ISSUED TO ............. ZTd YI~ ~L.&..R~C GA
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chap'rer 404 of the Laws of the
State of New York 1952: and 4'he Scut'hold Town Ordinance en-
4'itled "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance with 4'he
Resolu4'ion of The Board adopted a4' a meeting held on . .6/74./93 ....
19}73, and in consideration of the sum of $ paid by
of ....................................................... N. Y. and subiect fo 4'he
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees a~,'horizes and ~ermifs {'he following:
~ . . , - ~, ? .
Grandfather Permit to re~r e~st~ng b~khead and backfill
will be trucked in or .dr~dged from water as done in 1971.
Goose Creek
all in accordance wlfh the detailed specifications as presented in
+he originating application.
IN WITNESS WHEREQF, The said Board of Trustees here-
by causes its Corpora4.e Seal to be affixed, and these presents to
be subscribed bY a mai°ri4.Y °~/~_ez~id B.~rd as °f this daf'e.
TRUSTEES
John M. Bredemeyer, III. President
Albert J. Krupsld. Jr.. Vice President
Henry P. Smith
John B. Tuthill
William G. Albertson
Telephone (516) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
SUPERVISOR
SCOTT L. HARRIS
Town Hall
53095 Main Road
P.O. Box 1179
Southold. New York 11971
Office Use Only:
Coastal Erosion Permit Application
Coastal Erosion Variance Application
etland Permit Application
aiver from Chapter 97(Application
cTrUstee Lands Permit Application
Grandfather Permit Application
ompleted Apps. Date:
Inspection date:
CAC comments-Date: Sent Rec.
~Variance Required: (Y/N)
Neighbors notified-Date:
SEQRA Type __ .
~Coord.: Date sent
/SEQRA Determin./date:
Public Hearing/date:
Findings: Approved (Y/N)
Special Conditions: (Y/N)
(see file)
Permit[s) issued-date:
DATE REC.:
Application/Fee:
Application Number;SCTM$1000-
Applicant:
Address:
Interest: (owner, consultant,lessee,etc.)
Owner of Property: ~n~ L~0ccf~
Date:
Address IgC0 ~]'~
Subject Property Location:
Phone ( ) IQ0~c
(Provide LILCO Pole ~, Distance to cross Streets if not on
location map)
THIS IS NOT A PERMIT Page 1
Yds. to be excavated: I~; Yds. to be filled:
Manner in which material~il~ be removed or deposited:
c~n~' ' qJ -~
Width of al, d~ree ay ~onting property:
Depth at low tide: Aver. rise in tide:
Distance to nearest channel: O~C~ Distance project
extends beyond similar projects in area:
Area zoning: Land area in acres:
Is project for private or business use: ,'~, V:tO ~ ~O~jtO£~.~,~'
Describe known prior operations conducted on praises:
Has any prior license or permit been issued to erect structures,
dredge, or deposit fill on said premises:
Has any license or permit ever been revoked or suspended by a
Governmental Agency: ~0
Project Description
The project description must also include plans for reclamation
of land disturbed during construction of the principle and
accessory structures and underground structures (i.e., pipeline
and septic system; make additional attachments if necessary).
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