HomeMy WebLinkAboutTR-299 TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
E. iT No ......
Pursuant to the provisions of Chapter 615 of the LaWs of 1893 of the State of
New York and Chapter 404 of the Laws of 1952 of the State of New Yorkand in accordance
with the resolution of the Board of Trustees of the Town of S°Uthold adopted at a meeting
of said Board on ......~.~__~t~...~.,...~ .............. , and in consideration of the sum of
$....~i~0.., lawful money of. the United States, p
residing at ........ ..~t~:~,~a~..~,.~', ............................................................. New York,
the said Bayard of Trustees of the Town of ~uthold, Suffolk Count, New York, hereby
authorizes and permits said......~~..~..~ ................................ to
~s~11 ~ b~l~ ~n~ ~l~t~g ~ , all ~n ~or~n~
The said .~l.~..~g~.~.~...~.~..~.~..~_...D.$~ ._~-~.:.~..~ ............. , 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 any and all damages, claims for damages or suits that may arise or
occur directly or indirectly as e result of any operation 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 assum~ full liability with respect thereto to the complete exclusion of
said Board of Trustees and the Town of Southold.
It
THIS PERMIT is subject to the following terms and conditions:
1. That there shall be no unreasonable interference w,ith 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
OI6ng that portion of the bea~:h between Iow 'and high water mark.
,3.. That the work shaJ! be subject to the supervision and approval et, the said Board of
Trustees or its agents.
IN WITNESS WHEREOF, the said Board 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 y~ar cibove wri,tCen.
~c' .... ,~.'. ~Z~Z/..~,, ,.. ~: .......... (L. S.)
"z ~ ..(L.
STATE OF NEW YORK )
SS:
CO.UN'FY OF SUFFOLK )
ON THIS ........~-~;.~,~..day 0f....,~i~,~.~. .................................. , 19.C~5.., before me
~ersonally appeared
George S~son an~ J~n
all personally known
to me, who, being by me duly sworn, severally said that they each resided ~in the Town
of ~uthold, County 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 same; that they
knew the corporate seal of said Town of Southold, that the seal affixed to the foregoing
instrument was such corporate seal; that it was so affixed thereunto by order of the
Board of T~stees of said Town of Southold and that each one
a Trustee and by like order.
Notary Public
Ierm Wp[res ~arck 30, 19 ~T'
FOI~;~ NO. 1
TOWN OF SOUTHOI~D
BOARD OF TOWN TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ........................................ 19 ............ Application No...~,.,~',,.'.~,.~,~,,~z..?~'
Approved-.....~~.~.~.-~.~:.,'..(-?.i~.~;: ...................... Permit N,o ........ ..~.:./,/...~.. ~~
Disapproved o/c ............ ; ,..~,~. ~~ ........................................................... ~.~,~ .............................
......................................... !.....: ............................... chairman, Board of Trustees
.APPLICATION FOR PERMIT
INSTRUCTIONS
A. This opplioation to be completely filled in by typewriter or in ink and submitted to the Town Trustees in duplicate.
B. Plot plan showing location of lot end buildings on p~em~ses, relation to adjoining premises, public streets, parks, etc.,
-and g~ving detailed description of proposed layout of proje:ct must be drawn ow diagram which is part of this appli-
cation.
The work covered by this application may not be commenced before the issuance of o permit.
pon, approval of this application, Town Trustees will issue a permit to applicant, Such permit shall be kept on the
premises and available for inspection at ~11 times,
Applicant shall notify the Board of Trustees upon completion of the work covered by permit.
APPLICATION rs HEREBY MADE to the Board of Trustees of the Town of Southold, Suffolk County, New york, for the
issuance of a permit pursuant to the law~, ordinances and regulations governing construction of: docks, piers, bulF~heads,
jettys and dredging in; under, and over the waters of Town of Southold. The applicant agrees to comply wiCh all appli-
cable laws, ofdinances, regulations and conditions specified,by said trustees, and to hold the Town of Sobthold, and oil
Town officials ,free from liability and damages of any kind
'Nome of owner of premises ... , . ; ......
, ....................................
Street Address of Property .... '~1~ ~- ~', "J~i.t;~ ~ N.~]~. ..................................
Home Address If Other Than Lot:at'on ..... ~1~.~' '~'~"~~"'~'~i~,'t~i~;'l'"~~'-][~''''
Creek, Boy or Harbor Fronting Property ......... ~!~$~l~:...~'~z~ .................................................................................
Permit Re uested To' .
P q ' ~ -~.~' '~'~',. ]~.L~.. ~ - · ~!~'~ '~. · '~.~, .................................. ' ~e~i~ZL:'":;' ......... - .~-~1;:'
Size of reposed Walk Length ....~..~,.~.W~dth ....... ~..~ ...... He,ghth Above H gh Water ..........................
Depth Below Low Water ..................: ....... Average Rise In Tide ....... .~,.~..: Yards To Be Excavated ....... ~ ........
Width of Canal, Creeker Boy Fronting Property ......... ~.~..~,,~. ........ Depth at Low Tide ..,.~q~t~..~ ....................
Is This For Private Or Business Use? :....~l~l~..-t~t~ ..........................Area Zoning ......... ~..'~:~,~ ..................
Complete plot ~lan to,be drawn.on reverse side of this application.
STATE OF NEW YORK)
,) S.S.
COUNTY. OF
..................... .~/~,....,~ ....... being duly sworn, deposes ond soys thaf:.he ~s the applicant for fhe abOVe described
permit, end that oil statements contained herein are true to 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 Southo d, end the
apphcant agrees to hold the Town of Southold 'and said trustees harmless and free from any and all damages and claims
arising under orby virtue 0f S~d ~ermit; ..,? ,.~,,.,
(applicant)
Sworn to b~fore me th s ....... ~..... d0y 0f.. .~e~