HomeMy WebLinkAboutTR-1274Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. ~.7/~ ................ DATE:
ISSUED 1'O ................ ~.f~..e.....~.~.....~.c..~.~ ~'~ ....................................................
Pursusn~ ~o ~he provls~ons of ~h~p~r 61~ o~ ~he L~ws of
~he S~a~e o~ New York, 1893~ and Chapter ~ o~ ~he Laws of ~he
S~afe of New York 9~2~ ~nd ~he Sou~ho~d Town Ordinance
~i~led "RE~ULATIN~ AND THE PLACIN~ OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LA.NDS and ~he
REMOVAL OF SAND, ~RAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS:" and in a~ordance wi~h
Resolution of The Board adopted afa meeting he~ on ....~.M~.....~.~.
19...~..., and in consideration of ~he sum of $ ....~.~.~. paid by
of ...~.~ ................................................... N. Y. and subiect
Terms and Conditions I~s~ed on ~he reverse s~de hereof~
of Sou~hold Town 'Trusfees aufhorlzes and permits ~he
placement of a floating dock at Broadwaters Cove
off private proper~ of ~e applicant with
stip~ation that the dock not be more than 3~'long
all in accordance wifh the defaged specificaf[ons as presenfed in
the originating application.
IN WITNESS WHEREOF, The said Board of Trusfees here-
by causes its Corporafe Seal fo be affixed, and fhese presenfs
be subscribed by a major,fy of the said Board ~s of fhis
BOARD OF TOWN TRUSTEES
Town O~ Southold
Main Road
Southold, New York 11971
APPLICATION FOR FIXED and/or FLOATING DOCKS
,. App,cant's nome ond address: ........... ·
Z "7'- ........................
................... g.~.~.~.~.~ ...... z~.~..~. ........ d~...:~X.~ ......
..... ~....5~...~.~.....~2L~~OL~~....~.~.~.~_~...~..~.~.~..
.... ~.~ ~ ...... ~ ~'~ ...... L~....~.~....~.~d r,......~...~~....~....~
,.~....~..:~...~.....~.~...~...*. ....... ~~.~r~...~ ~/
4. A~ter iss~an~a ~{ a ~rmit, I axpact to: (mark by a~ ~
(a) Cam.ma~c~ work ~ AT ONCE ............ ; ASA~ ...~.....; ~NKNOW~ .............
%) Camplata work ia -- 1 PAY ............ ; ~ ~0 ............. ; ~ Y~ ............. ; ~ .............
A CIRCLE indicate as closely as possible the location of this dock. On the revere side of this
map, provide a SCALE D~WING which will sh,ow Ordinary High Water Mark, ~he shape
and size of the dock and an.y supplementaJ pilings which are ne~ed to hoJd a floating dock
or tie-up a boat. Give ~11 dimensions necessary to determine the area of the d~k surface
which extends offshore from the O. H. W. M.
6. Will any portion of this construction extend offshore i.nto Town Waters beyond an ima~
line or boundaw formed by other similar structures along the area's shoreline? YES o~ NOA/I/
If it d~s extend beyond this so-called d~k Jine indicate by how fair, approximately,......~/
7. Provide the following d~u.ments:
(a) A Licensed Engineer's Suwey of the property involved.
(b) A copy of the Contractor's Plans and Specifications.
8. Will this construction require the Filling of any land, offshore of the,~ Ordina~h Water
Mark or the Dredging of any material from Town Lands under water. YES ~ NO~f it does,/~
Form A/4 (Application for Dredging/Filling) must be compiet~ and attach~rt of this
application.
9. In requesting approval of this application, I submit that: the information presented herein
is true and correct to the best of my know~edge and belief; i am the per~n accountable for
the performance of the work in accordance with the plans and specifications attached; I have
read or am famiJiar with the provisions of any Southold Town Ordinance ~rtinent to the work
involved; and further, I intend to adhere to and abide by the Terms and Conditions of the
Permit, when a.nd if issued to me.
s .......... ............