HomeMy WebLinkAboutTR-1221Board Of Southold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO .......... ~:.~.[k ........... : - DATE: ...Zk,/~9.~.Z
ISSUED TO ........ .~ .e._:g:..e.......L_~._z?..e..~ .................................................................................. t .....
Pursuant to'the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 404 of the Laws of the
State of New York 1952; and the Southold Town Ordinance en-
titled "REtULATING AND THE PLACtN$ OF OBSTRUCTIONS'
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, ~RAVEL OR OTHER ~ATERIALS FRO~
LA~DS UNDER TOWN WATERS;" and ~n accordance with' the
Resolufbn of The Board adopted a+ ;~meef[ag held on ~.~....~.~..
19..~..., and in con~rafbn off he sum of $..]~.~..~._. paid by
Rene LeCren~ '
of ...~9.~.~ ......................................................... N. Y. ~nd sub[ecl ~o ~he
Terms end COndff[ofls 'l[sfed';Oh:'fhe reverse side hereof,~
of Sou~hold Tow~'"TrUsfee~ aufhorlze~'~nd permff~' the followb9:
exac~ Zooa¢&o~ ¢o ~e deCe~m&ned.
all in accordance with the detei[ed speciflcetlons as presented in
the orlglnafing applicafion.
by
be
IN WITNESS WHEREOF, The said Board of Trustees here-
causes ihs Corporate Seal't0 be affixed, and these presents ko
subscribed by a majority :of the sa!d Boacd as of~e.
..... ............
........... :...
'Trustees
BOARD OF TOWN TRUSTEES
Town (ff Southold
Main Road
Southold, New York 11971
APPLICATION FOR FIXED and 'or FLOATING DOCKS
1 Applicant's name and address: ...Z~.~.~.~.........~...~......C~...~..~.~ ...........................................................
2. Contractor's name and address: ....~..¢./.]~....z...~.~.....~.xf.¢...>1..¢ ......................................................
3. Briefly explain the purpose of this application: .....~.../..~./..d~.~.-~.~.~.~.',..~...~....~,., .....................
.................................................................................
After issuance of a Permit, I e~<pect to: (mark by an X9
fa) Commence work -- AT ONCE ............ ; ASAP .....~.'... ; UNKNOWN .............
(b) Complete work in -- 1 DAY ........... ; I MO ............. ; 1 YR....X.. ...... ; FUTURE .............
Secure the correct Area Map from the Secretary of fhis Board, and by using an X WITHIN
A CIRCLE indicate as closely as possible the location: of this dock, On the reverse side of this
mop, provide a SCALE DRAWING which will show Ordinary High Water Mark, fhe shape
and size of the dock and any supplemental pilings which are needed to hold a floating dock
or tie-up a boat, Give all dimensions necessary to determine the area of the dock surface
which extends offshore from the O. H. W. M.
Wiil any portion of this construction extend offshore into Town Waters beyond on imaginary
line or boundary formed by other similar structures along the area's shoreline? ~[i~;or NO.
If it does extend beyond this so-called dock line indicate by how fo.r, approximately, .......... ft.
Provide the following documents:
(a) A Licensed Englineer's Survey of the property involved
(b} A copy of the Contractor's Plans and Specifications.
Will this construction require the Filling of any land offshore of the Ordinary High Water
Mark or the Dredging of any materio from Town Lands under water?,~i~t¢ NO. If it does,
Form A/4 (Application for Dredging/Filling) must be completed and attached as part of this
application.
.Accepted by:
In requesting approval of this application, submit that: the information presented herein
is true and correct to the best of mv knowledge and belief; I em the person accountable for
the performance of the work in accordance with the plans and specifications attached; I have
read' or am fonqJl[ar with the provisions of any Southold Town Ordinance pertinent to the work
involved; and further, I intend to adhere to and abide by the Terms and Conditions of the
Permit, when and if issued to me.
Dated:
'x