HomeMy WebLinkAboutTR-928 SOUthold Town
Pur~Uenf-{.o' fhe Pr0~is|ons of chaPfer 6i5 °f i ws
~.he Slate 0f New York, 1893; and ~apfer 404 of fhe La~s °f
of New~ york 1952; and ~fhe Soufhold TOwn Ordlna
~ flfled ~RE~ULATIN~:AND THE PLACIN~ OFOBSTRU(
', IN AND ON TOWN WATERS AND PUBLIC LANDS
)F SAND, GRAVEL OR OTHER MATERIALS
of fhe sum of '
;~erms ~ and rjOndlt~onS~ listed On ,i-he rever~e side :hereo~,; ;
i:of SoUthOld:TOw,~: Trustees~ authOrizes ';nd i~rmfi-s the f°l°bing :
~Constrg~ dock' S2 ft, by 4 ft;::(o~'.aPpliCa~t,s
property) ~ ramp 8, ft. by 2 ft, 6 in,; ~Ioat 12 ~.
IN WITNES
~-he said BOard,
TOWN TRUSTEES
'S OFFICE
NEW Y~ 11971 APPLICATION FOR A PERMIT
A~'~licant}s Name: Ro~Fa~s
Address R R #l'~B~x237 '$0~tho!4, NeW.york
one or more of the following purposes:
TO MOOR A BOAT (secure & complete)
DOCK " Form
TO DREDGE AND FILL Form
OTHER PURPOSES---State and describe:
3. Name and Address of Contractor:
Ail work will ~e done by owner
4. Estimated date of commencement of work: May 1,t9~,3
Maximum number of months required to c0~¢te work. 3
5. Using a DOT WITHIN A CIRCLE as a mark, indicate on the proper
Zoning MaD-'as supplied by the Secretauy of this Boar~, the
location of this project, and attach;~his map as part of this
application.
6; List below all other forms or documents you are attaching:
l/i~. ~.2 ~ Engineers Survey ~ Working drawings
7. In requesting approval of this application, I submittthat: the
information presented here~n is true and correct to the best of
my knowledge and belief; I am the person accountable for the
performance of the work in accordance with the plans and specifi-
cations attached; I have read or am familiar with the Southold
Town Ordinance pertinent to the work involved; and I .intend co
adhere and abide by the Terms and Conditions of the Permit, when
and if issued.
XXXXX~XXXXXXXXXXXX XXX/~L~XXXXXXXX - i - XYL~XXXXX/~IXXXXXXXXXXXXXXXXXXX
8. Application % Amount of Fee--Form A/1--$ 5..00 Minimum
'. Date: ~--./~/~ Accepted by: J. ~ ~~
· ~ ' ~ Form A/~
BOARD OF SOUTHOLD TOWN TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLD, NEW YORK 11971 CONSTRUCTING A DOCK
1."J Does this project involve the use of WETLANDS as defined in the
Wetlands Ordinance? ~ (yes or no). If so, your application
should be filed through the Southold Town Clerk.
2. Will the work require the filling of any land beyond'Mean High
WaterMark or the dredging of any Town Lands under water?
No (yes or no). If so, Form A/5 must also be completed
and attached as part of this application.
3. State brieflE the intended use for this structure:
-~ 4. .Will any,portion of this construction extend into Town Waters
' · beyond a theoretical boundary formed by other existing docks or
Similar structures? ~e (yes or no). If so, by how much__ft.
Provide a copy of a Licensed Engzneer's Survey of your property
and by means of your own diagram drawn to scale thereon~ show
the nature of the work to be done in relation to your own premises,
high water mark, and the adjacent body of water.
6. Provide a copy of the plans or drawings which will b~ supplied no
· : ~ i the Contractor performing the work.
In requesting approval of this application, I declare there will
be nG interference with the right of the public to pass and
repass along the beach between high and low water marks.
Computation.of Fee: (for use of the Board)
Area of the construction beyond M.H.W. ~ the rate of
10¢ per sq. ft., plus $1.00 per piling for supplemental
Rober% 14a~s