Loading...
HomeMy WebLinkAboutTR-170 TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES NO ........ / Stake Pursuant to the provisions of Chapter 6]5 of the Laws of ]893 of the State of New York and Chapter 404 of the LaCvs of '1952'of the State of New York and iH a~cordance with the resolut~onof the Board of Trustees of the Town of Southold adopted at a meeting of said Board on.....~..~,~...~.~ ....................... and in consideration of the sum of Sk.~.~.~, lawfu money of the United States, paid by..,.;~...~.,~...~ .................... residing at ......... .~,~.~.~.~.,.~.~.~.:.~.~..~....~...~.~..~..~ ........................... , New York, the said Bgard of Trustees ~f the Town of Southold, Suffolk County, New York, hereby authorizes and permits-said ..............,..~....~...~.~..,.,~.:~.~;.~.~. .......... ...................................... to su.1:m~ce.e~. The said ..... ~.,~,....~;~1~ ................................ , as part of the consideration for the issuance of this permit does hereby release the said Board of Trustees and the Town of Southold from (~ny and all damages, claims for damages or suitsthot may ariseor occur directly or indirect]y as a result of any'operotio~ carried an untler and pursuant to this permit, and will' at hlsown expense, de{er~d any ~and all suits which may bebrought by third parties as a result of any operation carried on pursuant to or in accordance with the terms o~ this permit, and assume full~ lial~ility with respect thereto to the complete exclusion of said Board of Trustees and the Town of Southold. FORI~I NO. 1 TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .%~-~+..~ ............. 19.6..%~. Application No .................. Approved ...C.'~,~-,-~-~,-~...Cf~...-~,.~ ......... Permit No ...... /.7.~.. ............... Disapproved a//c ................................................................... ~....~....~..~.. :."~.~~...~'~'"~~ .......... chairman, Board of Trustees APPLICATION FOR PERMIT INSTRUCTIONS A. This application to be completely filled in by typewriter or in ink and submitted to the Town Trustees in dup- licate. B. Plot plan showing location of lot and' buildings on premises, relation to adjoining premises, public streets, parks, etc., and giving detailed description of proposed layout of project must be drawn on diagram which is part of this application. C. The work covered by this application may not be commenced before the issuance of a permit. D. Upon approval of this application. Town Trustees will issue a permit m applicant. Such permit shall be kept on the premmes and available for inspection ar all times. E. Applicant shall notify the Board of Trustees upon completion of the work covered by permit. APPLICATION IS HEREBY MADE to the Board of Trustees of the To~vn of Southold, Suffolk County, New York. for the issuance of a permit pursuant to the laws, Ordinances and regulations governing construction of: docks, piers, bulkheads, jettys and dredging in, under, and over the waters of Town of Southold. The applicant agrees ro comply with ali applicable laws, ordinances, regulations and couditions specified by said trustees, and to hold the Town of Southold, and ali Town officials free [rom liability and damages of any kind. Name of owner of premises ......... ~,I.o/.vf.a. iT.d' . .B.:. ~e..e. ....................................................... Street Address of Property ......... Y..OUflgB..A.V{)/I'O~ ...................................................... Home address If Other Than Location ......... .-.-. ............................................................. Creek. Bay or Harbor Fronting Property ... ~/.o. gk~y...C.l?.p.e.k ................................................... Permit Requested To: .... O,~e.~ $..~..dD. Qk.~..437~.c~ ~. ~,r~ .p~,~..iD... ~. ~/.o. ~.tiy., ........................... Size of Proposed Work: Length.. ~O..f'O.~i~ ...... X¥idth. ~. ,C..e~.'b .... Heighth Above High Water....~. Depth Below Low Water, .~..~...e.e..~ ...... Average Rise In Tide...3...I?p.e..~...Yards to Be Excavated .............. Width of Canal, Creek or Bay Fronting Property..~..0...f'p.e..~. ........ Depth ar Low Tide ...1..f'..o.o..~. .......... Is This For Private or Business Use? . .Y.~s ............................ Area Zoning,~.g':~.-~./../.~..g?¥Z fA Complete plot plan to be drawn on reverse side of this application. STATE OF NEV~ YORK ) )s.s. COUNTY ~ /'"/f'~. ' '~-i~ ' ' being · duly sworn deposes and says that he is the applicant for the above de- scribed permit, and that all statements contained herein are true ro the best of his knowledge and belief; that the work will be done in the manner set forth in the application and as approved by the Board of Trustees of the Town of Southold. and the applicant agrees to hold the Town of Southold and said trustees harmles~ and free from any and ail damages and c!aims arising under or by virtue of said permit. (applica~' /. Sworn ~ ' ..,~.~ ...... day of. IgOr/... 19. Nota~ ~tate of Ne2~ G2~w Yor~~ No. 52-1359230 ~ Suffoik Ce~ission Expires >~m-. 80. 19 ~ Il THIS PERMIT is subject to the following terms and conditions: 1. That there shall be no unreasonable :nterference with navigation as a result of the ~,(.~4rein authorized. :~ '~¢?~'' 2. That there shall be no interference with the right of thepubllc to pass and repass along that portion of the beach between Iow and high water mark~ 3. That fha work shall be subject to the supervision and approval of the said Beard of Trustees or its age, ts. IN WITNESS WHEREOF, ~'~ said Board of Trustees of the Town of 5outhold has caused its corporate seal to be hereunto affixed and these presents to be subscribed by a majority of the said Board Of T~u~tee~,. the d~y and year above written. seal STATE OF NEW yORK C' ' ?'~'; . ,~SS;.. OUNTY OF 5uI~FOLK 'ON TH tS..,: pe. rsona ly appeared to,,me, Who; being ., 19.~.., before me all personally known Sworn, severally said that they each resided in' the Town ' ' '~bf So~thold~ County/of Suffolk, State Of New York, and were members of 'the Board of · '~ Trustees of said T~wn of Sauthold, and, const tuted o major ty of the same; that the,, / knew the corperot~'seal of~a'd Town of 5outhod; that the sea aft xed to the forego ng / instrument was ~h Corporate seal; that t was so affixed thereunto by order of the // Board of Trusteeg/of said Town of ~uthold and that each one signed his name thereto as ~ Trustee and ~' ' ~ I ke order. · NEtary Public Cemm,ssi0n Expires ~arch 30, l~&-~