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HomeMy WebLinkAboutMOELLER, ROBERT-CANCELLED TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES PERN[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 York and in accordance with the resolution of the Board of Trustees of the Town of Southold adopted at a meeting of said Board on....~..~-,4~ ......................... and in consideration of the sum of $..f~g~.., lawful money of the United States, paid by ........... residing at ....... ~,~..~[~..E~ .............................. New York, the said Board of Trustees of the Town of Southold, Suffolk Ceunty, New York, hereby authorizes and permits said...~..~..~.'. .~, .............. :.. to The said~.~. ~r..~-.~~F, as part of the consideration for ~ne ~ssuance o~ rms permit does hereby release the said Board of Trustees and the Town of Southold from any and ~11 damages, claims for damages or suits that may arise or occur directly or indirectly as o result'of any operation carried on under end pursuant to this permit, and will at his own expense, defend any and all suits which may be brought by third parties os o result of any operation carried on pursuant tear in accordance with the terms of this permit, and assume ful liability with respect thereto to the complete exclusion of said Board of Trustees end the Town of Southoldo TH] S PERMIT is subject to the following terms uno conditions: 1. That there shall be no unreasonable interference with navigation as c~ result of the work herein authorized. 2. That there sha be no interference with the right of the public to pass and repass along that portion of the beach between Iow and high water mark. 3. That the work shall be subject to the supervision and approval of the said Boa.rd of Trustees or its ggents, IN WITNESS WHEREOF, the said Board of Trustees of the Town of Southold has caused its corporate seal ¢o be hereunto affixed and these presents to be subscribed by a majority of the said Board of Trustees, the day and y~or :above written, ) STATE OF NEW YORK ) SS: COUNTY OF SUFFOLK ) ON THIS.....~.~.~... ...... day of ............. ~Z .................................. , 19 ~.~.., before me personally appeared ~/~.~ ~. '~'~'~"~"~¢~ ~~ ~ E~ all personally known to me, who, being by me duly sworn, severally said that they each resided in the Town of Southold, County of Suffolk, State of New York, and were members of the Board of Trustees of said Town of Southotd and constituted c majority 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 Trustees of said Town of Soathold and that each one signed his name thereto as ~ Trustee and by like order~ Notary Public FOE~ NO. ! TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........~H..-.~.~~,,/,~ ~ ~ 19~...~, ~ ~ Application No ............................... APPLICATION FOR PERMIT INSTRUCTIONS A. This application to be completely filled in by typewriter or in ink and submitted to tee Town Trustees in duplicate. B. Plot plan showing location of lot and buildings on premises, relation to adjoining premises, public streets, parks, etc., and giwng detailed description of proposed layout of project must be drawn on. diagram which is part of this appli- cation. C. The work covered by this application may not be cart menced before the issuance of a permit. D. UPOn~ approval of this application, Town Trustees will issue o permit to applicant. Such permit shall be kept on the premises and available for inspection at a~ll times. E. Applicant shall notify the Board of Trustees upon completion of the work covered by permJt. APPLICATION IS HEREBY MADE to the Board of Trustees of the Town of Southold, Suffolk County, New York, for the issuance of a ~ermit pursuant to the ~o~vs, ordinances and regulations governing construction of: docks~ piers, bulkheads, jettys and dredging in; under, and over the waters of Town of Southold. The app[icant agrees to comply with all appli- cable laws, ordinances, regulations and conditions specified by said trustees, and to hold the Town~ of Southold, and all Town officials free fram liability and-damages of any kind. Name of owner of premises .......................................................... Street Address of Property ..~..4~./.~. ...... ~..~...~..~....~..~..'. .................................................................................................... Home Address If Other Than Location ...................................................................................................................................... Creek, Bay or Harbor Fronting Property ...... -- ".?.'...~..g./~'..E../ ......... .C..Z~.~...~. ....................................................................... Permit Requested To: ....... ~.~ .~...~...~.~. ...... ; ................................... :. ................................................................................... Size of Proposed Work: Length ...~...~...~......~ .....Width ......~..~......~.~.~ ..... Heighth Above High Water ........ ~.'~.._. ............. Depth Below Low Water 3 -- .~..~..~..~.... Average Rise~ln Tide .....~.....~.i .~. ...... Yards To Be Excavated Zk2 ~.. C~) Width of Canal, Creek o;'~'~';"Fr~ntir~;"Prop~erty,....~....?......~../. ............. [.[[.[";epth at,,kpw Tide ...¢~...~..;i..~.'~" .~.'i.ii[[iiiiiiii[[i Is This For Private or Business Use? ...........~.Z'~./.'...b/.~..~.~. ...................... Area Zoning):i('~...E'..~..~...c~....~'..~.~, .~../~'9./. .................. Complete plot plan to be drawn on reverse side of this application. STATE OF NEW YORK) ..... ~.&.a./.~.~...~.~.~..~. ............... being duly sworn, deposes end ~ys that he is the ~pplioant for the ~boVe described permit, ~nd t2ot oll statements contained herein ~re t~e to the best of his knowledge ~nd belief; that the work will be don~ in the manner set foffh in the application and as approved by the Board of Trustees of the Town of Southold, and the applicant agrees to hold the Town of Southoid and sa.id trustees harmles~ and free fr~m any and all damages and cl~im~ under orby virtue of said permit.