HomeMy WebLinkAboutMELIN, FREDBOARD OF TOWN TRUSTEES
Town of Southold
Main Road
Southold, knew York 11971
1. Your application, dated ...... .~..n...n..e.....d;.,.....1.p.8..~. ..................................... has been reviewed by this
Board, at a meeting of the Trustees held on ....... .~.u..~,y.....$.,.....1.~..8...], ............... '. ........................................
and resulting in the action, as indicated below:
Application approved.
Application denied.
Application tabled.
2. Comments and remarks: To deny application to extend an existing float.
3. If your application is approved above, A Permit Fee s now due, and should be made payable
to the order of the Board of Southold Town Trustees. This fee is computed below according to
the Schedule of Rates as set forth in the instruction Sheet (Form 1/11.
If the Permit Fee is paid in person Fo the Secretary of the Board, The Permit will be ob;-ainable
at the same time. If the fee ~s paid by mail, the permit will be mailed in reply.
Computation of Permit Fee:
Total Fee for this application ............................................................ $ .........................................
~igned ..... ~.~..~~. ~~
(_..~t.4~,, '~ Board of Southold Town Trustees.
BOARD OF TOWN TRUSTEES
Town Of Southold
Main Road
Southold, New York 11971
APPLICATION FOR FIXED and/or FLOATING DOCKS
1. Applicant's name and address: ...... /......~.~.....~ ................................. ~ ................................................
2. Contractor's name and address: ...... .~..,~.~ ...................................................................................
After issuance of a Permit, I expect to: (mark by an )~)
(a) Commence work -- AT ONCE ............ ; ASAP ..?~.....; UNKNOWN .............
(b) Complete work in -- 1 DAY ............ ; 1 MO ............. ; 1 YR ............. ; FUTURE .............
Secure the correct Area Map from the Secretary of this Board, .and by using an X WITHIN
A CIRCLE indicate as closely as possible the location: of this dock. On the reverse side of this
map, provide a SCALE DRAWING which will show Ordinary High Water Mark, the shape
and size of the dock and any supplemental pilings which are needed to hold a floating dock
or tie-up a boat. Give all dimensions necessary to determine the area of the dock surface
which extends offshore from the O. H. W. M.
Will any portion of this construction extend offshore i.nto Town Waters beyond a.n imaginary
line or boundary formed by other similar structures along the areo's shoreline? YES~ or NO.
If it does extend beyond this so-called dock line indicate by how fa:r, approximately,. ......... ft.
Provide the following docu,ments:
(a) A Licensed Engineer's Survey of the property involved.
(b) A copy of the Contractor's Plans and Specifications.
Will this construction require the Filling of any land offshore of the Ordinary High Water
Mark or the Dredging of any material from Town Lands under water? YES or NO. If it does,
Form Al4 (Application for Dredging/Filling) must be completed and attached as part of this
application.
In requesting approval of this application, I submit that: the information presented herein
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 specifications attached; I have
read or am familiar with the provisions of any Southold Town Ordinance pertinent to the work
involved; and further, I intend to adhere to and abide by the Terms and Conditions of the
Permit, when and if issued to me.
Accepted by: Dated:
ye
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