HomeMy WebLinkAboutTR-1030Board Qf :$0Uthold Town Trustees
SOUTHOLb, NEW YORK
PERMIT NO: ..,~.0~9:. DATE: ..y~}~.!Y ~.._ 1974
ISSUED'TO ...................... ~yr.~ ~atl~w
t~ ,~ ~ ' Pursuan~ fo fhe provisions Of Chaplet 615
fha Sfafe of New York,: 1893;,and ~apfer ~4 of fha L~Ws ~f~e
~?f~ of New'Yor~ 952; and.fEe Soufhbid Tow. O~innnc~'eh-
rifled "REGU~TING AND THE PLACING OF OBS~UCT~ONS
IN AND ON TOWN WATERS AND PUBLIC ~NDS and fha
REMOVAb OF SAND, ~GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" end i~ ~ordance wlfh fee
Resolution o~ The Board' adopfed afe ~eefln~ held
, 19..Z.~ , and in cons~derefio, of fha sum of $~.~...; .... paid
~.~...~a.A~.~. . ...............................
0f Q.!.~.~F~.~....~9.~..c.~.~9.~e.. N. Y. and sub,ecl fo fee
Terms ~nd Cond~f~ons llsfed on fha reverse side he'eof,
~o~ Soufhoid Town Trusfees aufhorizes and perils ~He ~oJow~n~:
~a~e stick for stick replace of bulkhead at his
propeuty On Wunneweta Lagoon~ off Bayberry Read
and Ciear~er Lane~ Cutchogue, New York.
a~ ~n acc~ance wi~h ~he de~ai[ed speci~cafions as pre~n~ed
fee O~iglneflng appllca+[on.
IN ~I~NESS WHEREOF ~e sa~d Board of TrusSes ~re-
by Cau~ps ifS, Co~p6raf4 SeaJ fo be a+fixed, and:
be :~bs~ri~d bV ~ :mejorify of. fha said Board as '~
TERMs an~'C'ONDITJONS :t '~
~ii' Tlm P~mkt~ Myr0n Matlaw
Clearwater Lane, Nassau Po_nt, Cutchogue t1935N. ¥., as
~e co~d~fi0n f~ ~e ~ 0f ~ P~t d~ ~ ~ p~ ~o ~e fol-
~at ~e ~d B~d ~ T~ ~d ~e To~ of ~old ~ ~ ~ ~y ~
~p~ t0 ~ ~ ~ &~ ~d Pe~ ~ at ~ ~ ~q
T~t ~P~t ~ v~d for a of ~ w~.~ ~ to ~ ~e
but'~o~d ~m'w~ r~u~t
~ ~mion my .be ~de-to ~e ~ ar .a la~ ~
~ Pe~t ~o~d ~ te~ ~def~y, or as long m ~ ~ P~ ~
*e ~e or pmj~ ~volv~ to pro. de ~d~ m ~o~ ~m~ ~ ~*~ j~
o~on w~ o~117 ~ ~ ~
~m~,-~d no~mp~ ~ ~e pro~siom of ~ ofi~ ~ppH~o~ ~y ~ ~me for
h' ~d 1~ wa~r ~ks.
~ ~e Towa of ~[d ~ ~v~ md/or ~fiom
t6 r~o~e or ~t~ ~work or proj~ h~e~ ~ ~om ~ to ~e Tom
g.~ ~a~ ~e ~d Bo~d wU} ~ n~i~ ~ the Pe~ m ~ ~ ~ ~e ~ ~-
~ent~ m* ~ ~ ~ ~y, ~ ~ to ~o~ upon ~ m ~ ~
BOARD :O? SOUTI{OLD TO~¢~N TRUSTEES
rev/6 · 72
A~..L~C~TtO~-, ~0~ A BULKHEAD, DIKE, OR JETTY.
1. Does this project involve the use of~WET~NDS as defied in the
$outhold To~ ~etl=nds Ordinance? YmSo~O). If it does you
must file through the To~ Clerk's Office
2. Is the proposed work entirely with~ the bo~daries~your~
property as substantiated by your Deed or Survey? (YE~or NO.
~f it is, a Permit is NOT required from this Board,~u~ the
Io,~ BulldOg Inspector should be contacte9 for full details.
3. Applicant's name & address:
6. After zssuance of Permit, I exnect to: (mark with an X)
(a) Commence ~ork ..... AT ONCE ; ASAP ; UNkq~OWN TIME
(b) ~om~lete work~in--1DAY ; 1MO. ~ ; 1~ ; F~TUR~
Secure the cor~'ec~ Ar=a Map from the Sec~-etary of this Board~ aha
by usLng an X WITHIN A CIRCLE as a mark, ~dicate as closely as
possible the location of this project. On the reverse side,
provide a SCALE DRAWING which will show Ord~ary High Water Mark
as well a~ the size and shape of the structure or work to be done.
Also include all dimensions for port~ons which extend o~fshore
from the O.H.W,M.
8. Provi~he follow~g documents:
((a)/~A Licensed Eng~eer~s~Survey of the property involved.
~A copy of the Contractors Plans & Specifications.
9. Does this project extend into Tow~ Waters beyond an ~aginary
t~e or boundary formed by ~xist~g ~ks of a s~ilar nature
along this area's shore!ine~ YES o~} If it does, state the
approximate distance beyond, ft.
t0. Will 'this construction require the Fitl~g of any land offshore
of t~e Ordinary High Water Mark or t~redging of any ~terial
from To~ Lands under water? YES o~NO] !f it does, Form A/4
(Application for DredgingfFilling) m~ be completed and attached
as part of this application.
1t. !n request~g approval of this application, I submit that: the
~formation presented here~ is true and correct to the best of
my ~owledge and belief; I am the person acco~table for the
perfor~nce of the work Ln accordance with the plans and spec-
ifications attached; ! have read or am familiar with the pro-
visions of any Southold To~ Ordnance pert~ent to the work
involved; and fur~her,I intend to adhere to and abide by the
Terms and Conditions of the Permit,when and if issued to me.
xxx xx xxxxxxxx x x xxxxxx x : (xxx xxx xx
Accepted by: ~ ~ Dated: