HomeMy WebLinkAboutTR-141 TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
P£R~MIT NO .................
Pursuant to the provisions of Chapt~er 615 of the Laws of 1893 of the State of
New York and Chapter 404of the Laws afl 952 of the State of New York ahd ii~ accordance
with the resolution of the Board of Trustees of the Town of Southold adopted at c meeting
of said Board an ........... . .[~..~.....2..9.~.~...1..~.6..]... ..................... , anc~ in consideration of the sum of
$_.~..:..~..O......, lawful money of the United States, paid by.......~(;~...s.~.~...~.~..-.....~..~.~. ..........
residing at ............ ~,~f,~..~@~...~t~.~..~,~.~l~...~.I, ........................... , New York,
the said Bgard of Trustees of the Town of Southold, Suffolk County~ New York, hereby
authorizes and permits said ........ ~..~..~;;..e....~,,....~.!~E~j~. .............................................. to
The said .............. ..~....S.~.~.....~.z...~ .~?....a~.. .................. , as port 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 afl damages, claims for damages or suits that may arise or
occur directly or indirectly as a result of any ~peration 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 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 end the Town of Southold.
I[
THIS PERMIT is subject to the following terms and conditions:
1. That there shall be no unreasonable interference with navigation as a result of the
work herein authorized.
2. 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.
3. 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 Beard 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 year above written.
............ (L. s.)
(L. S.)
STATE OF NEW YORK )
SS:
COUNTY OF SUFFOLK )
ON THIS .......~..G....~...,..day of ............. ~.~. ................................. 19,.~.., before me
personally appeared
O~ ~ien~. ~ ~ ~ ~l~h, o~ ~t~ll~rsonully known
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 of the Board of
Trustees of said Town of Southold and constituted a majori~ of the ~me; that they
knew the corporate seal of said Town of Southold; that the seal affixed to the foregoing
instrument was such corporate seal; that Jt was so affixed thereunto by order of the
Board of Trustees of said Town of Southold and that each one signed his name thereto
a Trustee and by like ~der,
~ ~ublic .................
FOR~ ~0. 1
TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
TOWN C[:ERK'S OFFICE
SOUTHOLD, N. Y.
Application No ..............................................
Permit No .......... ...................................................
Disapproved a///c
.~....¢~_._.~..,~ chairman, Board of Trustees
// APPLICATION FOR PERMIT
INSTRHCT~ONS
A. This ~pplication to be completely filled in by typewzriter or in ink and submitted to the To,wu Trustees in dup-
licate.
B. Plot plan showing' location of lot amd buildings on premeses, relation to adjoining premises, public streets,
pa~ks, etc., and giving detailed description of proposed layout of project must be drawn on diagram which is pa~t of
this applics~t~on.
C. The ~vork covered by tl~iz application may not be cqmmenced before the issuance of a permit.
D. Upon approval of this applica,tion, Town Trustees will issue a permit to applicant. Such pern~t shall be kept
on the premises and available for inspection at all times.
E. Applicsmt shah notify the Board of Trustees upon. completion of the work covered by permit.
APPLICATION IS HERERY MADE to the Bomrd of Trustees of the Town of Souehold, Su¢folk County, New York,
for the issuance of ~ per,it pursuant to the laws, Ordinances a~d regulations governing construc¢~on of: docks,
p~ers, bulkheads, jettys and dredging hi; un~er, and over the waters of Town of Sou~hold. The applicmnt agrees
to comply with all applicable laws, ordinances, regulations aud conditions specified by said trustees, and to hold
the Town of Southo~d, and all Town ofltoia!s free from liability and damages of any kind.
Name of owne~ of premises .............. ~._e..~.'.l.~.._.~,....~..a~_.n.. ...................................................................................................................................
Sereet Address of Property t~ail~ Ed. ~ East ~rion~ N.Y.
Home address If Other Tha~ Location
Creek, Bay or Harbor Fronting Property ...__D..~....?._.O..~.~._..~....~.....~...O..~f~.....~...1T...~.~.~
Permi~ Requested To: .~.~..~..~p.....~t¢~k`..s~....~.a....m~.-~.o.nd.~..dde.s....neimhe.~.m~..-~D~nant ................................................
Size o¢ Proposed Work: Length ..~.~.~_..~[~ ............... Width ....~....~ ............... Heighth Above High Water ....... .~.__..~_.t..
Depth Below Low Water ._..~-_--f~ ............. Average Rise In Tide .._3....J[..t. ............... Yards to Be Excavated _~.~..~..0....0...0.. ............
Width of Canal, Creek or Bay Fronting Property ........ .~....~_.t.. ......................... Depth at Low Tide .........~.....~..t..
Is This For Private or Business Use? .~l~h~J_c.._~t;.~r...}~[~ ............. Area Zoning ...........................................................................
Complete plot plan to be drawn on reverse side of this application.
STATE OF NEW YORK)
~ )S. S.
work will be done in the, ~na~ner set forth in the' applicatio~ and as approved by the. Bus. rd of Trustees of the Town
of Southold, and the applicant agrees ¢o ho~d the Town of Southold and said trustees harmless a~l free from a~y
~nd aH damages and claims a~sing under or by virtue of s~d pe~t.
Swo~ to befo~ me ~s .-.-. ~..~.~.-- day of ..~.~.~.~_. 19..~...~... ,
motary public ~_~(~.:.~ty oI' .~ ~, ~ub~;,, ~'~ ~r .... .