HomeMy WebLinkAboutTR-E 111-15-8.2Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. ~ [1~ ~S-?.9.- DATE: ~
ISSUED TO ......... i.~o~'~.~ ~'~.~'-..~.~'~
ulhorizatian
Pursuant fo the provisions o~ Chapter 615 o~ the Laws o~
fha S}a~e o~ New York, 1~3; and C.hap~r ~ o~ fha L~ o~ the
State o~ New Yor~ 1952; and fha Soufhold Town Ordinance en-
titled "RE~ULATIN~ AND THE PLACIN~ OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and
REMOVAL OF SAND, ~RAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WA~RS;" and in a~cordance with the
Resolution of The Board adopted et a meeting held on
19 , and in consideration of the sum of $ ~-xc~ paid by
of ............. N.Y. and subject fo the
Terms end CondiHons listed on the reverse s~de hereof,
of Soufhold Town Trus+ees eufhorlzes and permits the following:
,
all in accordance wifh the detailed speclficaflons as pre~nfed in
the orlglna~ing application.
IN WITNESS WHEREOF, The said Board o~ Trustees here-
by causes ifs C0rpora}e Seal ~o be a{{ixed, and these presents
be subscribed by a majority of ~e sald~ as 0f this dat, e.
TERMS and CONDITIONS
The Permictee
residing at N.Y., as
part of the consideration for the issuance of the Permit doe~ unde~tand and prescribe to the foi-
lowing:
1. That the ~aid Board of Trustees and the Town of Southold are relea~d from any and
all damages, or claln~ for damages, of suits arising directly or indirectly as a result of any oper-
ation performe~ pursuant to this permit, and the said Permltt~e will, at his or her own expense,
defend any and all such suits initiated by third parties, and the said Permittee assunles ~ liability
with respect thereto, tx) the complete exclusion of the Board of Trustees of the Town of Southold
2. That this Permit is valid for a period of mos. which is considered to be the
estimated time required to complete the work involved, but should circumstances warrant, request
for an extension may be made to the Board at a later da~e.
3. That this Permit shguld be retained indefinitely, or as long as the s~tid Perm~ttee wishes
to maintain the structure or project involved, to provide evidence to anyone concerned that
orizatlon was originally obtained.
4. That the work involved will be subject to the inspection and approval of the Boerd
its agents, and non-compliance with the provisions of the originating application, may be ca~se for
revocation of this Permit by resolution of the said Board.
5. That there will be no unreasonable interference with navigation as a result of the work
herein authorized.
6. That them shall be no interference with the right of the public to pass ~nd repass along
the beach between high and Iow water marks.
7. That if future operations of the Town of Southold require the removal and/or alterations
in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the
work shaLl canse unreasonable obstruction to free navigation, the said Petmittea will be require~
upon due notice, to remove or alter this work or project herein stated without expenses to the Town
of Sonthold.
8. That the said Board will be notified by the Permittee ol the completion of the work
orized.
9. That the Pcrmittee will obtain all other permi~ and consents ~t nm), be requ~ed sup-
plemental ru this permi~ which may be subjec~ to revoke upon f~dim-e eo o~ain same.
TRUs'rEES
1okn M. B~ede. meyen ~, P~idant SUPERXqSOR
Hemy P. ~; ~ ~idefit ~ SCO~ L. ~S
AI~ L K~, Ir.
i~ L. ~, I~. To~ HaH
~ ~ ~:'~ 53~5~inRoad
~o~ B~ T~I1
P.O. Box 1
Telepfio~e (~i~) ~65-189~ BOARD OF TO~ ~RUSTEES ~u~old, New York 11971
F~ (516) 765-1823 TO~ OF SO--OLD
COASTAL EROSION MANAGEMENT PERMIT APPLICATION
TOWN WETLANDS PERMIT APPLICATION
TRUSTEE LANDs PERMIT .APPLICATION
Office Use Only:
~Coast~l Rr0~on Per~it application
J~We%i~hd Permit Application
~Trustee Lands Permit Application
_~C0mpleted Apps. Date.
~Variance Required,
~_SNeighbors notified Date:
SEQRA Type ~ ~
Co0~d~;~Review-opt.,mand. Date Rec. by Office
~Insp,.co~p?/date:
~SEQRA, betermin,/dat~:
Public Hearing/date:
Fihdings:
P~mit v6te: (Y/N):
Sp~ciaI Conditions:
(~1~6 ~ee file) Application Fee:
Applic&ti0h NtufiDe~; SOTM ~t000- ~l]~l~- ~
Project Na~ (If any) ~~ ~~k~
Interest: (owner, conSultant,lessee,etc.) ~
subject ~=oper%y Location. [/ ~D~0~ ¢& '
(Provide LILCO Pole ~, Distance to cross Streets if not on
location map)
THIS IS NOT A PERMIT
Yds. to. be excavated: ~)/~ Yds. to be filled:
Manner in Which material will be removed or deposited:
Width of canal, c~e~,or bay fronting property:
D~Pth a~.l~w tide: ~ Ave~. rise in tide:
Dls~d~e~6nearest dhannel: Distance~ject
exte~d~ b~y0hd simila~projects in area:
A~ea kOhing:'~l~ Land area in acres: ~
Is project for p' -r~vat' '~e or business dse:
Intended Use of property: ~~ ~ -- ·
Describe known pr%or operations c6n~ted on premises.
Has any prior license or permit been issued to erect structures~
dredge~ or deposit fill on said premises: ~/~
Has any license or permit ever been revoked or suspended by a
Governmental Agency: ~ ~
Project Description
The project description must also include plans for reclamation
of land'diSturbed during construction of the principle and
accessory structures and underground structures (Joe., pipeline
and~septic system; make additional attachments if necessary).
AuthoriZatlon(Wherethe~applicant' is not the owner)
I residing at
(Print~owner of subject property) (Mailing address-phone)
do hereby authorize to apply for
Coastal'Erosion permit(s) from the Southold Town Trustees
Signature
THIS IS NOT'A PERMIT
County of Suffolk
State of New York
~eocq~_ ~, Co~+el[~, ~/ BEING DULY SWORN DEPOSES AND
AFFIRMS~THAT NE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED
DERMIS{S) AND THA~ ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO
THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT WORK WILL BE
DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE
APPROVED BY THE souTHOLD TOWN BOARD O~TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TOWN-OF SOUTHOLD AND THE TOWN TRUSTEES
HARMLESS-AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY yIRTUE OF SAID PERMIT(S), IF GRANTED.
IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,
THEIR AGENT{S) OR REPRESENTATIVE(s), TO ENTER ONTO MY PROPERTY
TO. INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS
APPLICATION.
NATURE
swo~ TO ~EFORE ME THIS ~¢~ DAY OF ~'q~uor~ ,~_~
Suggested space for location Map
THIS IS NOT A PERMIT