HomeMy WebLinkAboutTR-136 TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
...... .....
Pursuant to the provisions of Chapter 6]5 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
af said Board on ........ ~'.~b.,....$.,..J,~.~, .......................... an~ in consideration of the sum of
$...j.~;~..~.u..., lawful money of the United States, paid by......,I.O~.~)L~A. ....................
residing at ...... w~.s,Z...Me~f:...~.i~...Dr/,~.,...~at.~./,tu~,...L..l~ ............ New York,
the said Board of Trustees of the Town of Southold, Suffolk County, New York, hereby
authorizes and permits said ..............J~e;Lo.h..MoJ. sa. .................................................. to
=e~ge the erc~ a~a in £~ont o£ his ~rol~r~y on
~att!~uck Creek a~Join/~g Morton ~hilli~s~ all in
The said ....... ~..f~.~]~3..~g.~,~.~, ................................. , as part of the consideration
for the issuance of this permit does hereby release the said Board of Trustees and the
Town of Southold from any end all damages, claims for damages or suits that may arise or
occur directly or indirectly es a result of any operation carried on under and pursuant to this
permit, and will at his own expense, defend any and all suits which mc~ be brought by, third
parties os a result of any operation carried on pursuant to or in accordance with the terms of
this permit, and assum~ full liability with respect thereto to the complete exclusion of
said Board of Trustees anc the Town of Southold.
THIS PERMIT is subject to the following terms and conditions:
1. That there shall be no unreasonable interference with navigation as a result of the
work herein authorized.
2. That there shall 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 Board of
Trustees or its agents.
IN WITNESS WHEREOF, the said Board of Trustees of the Town of Southold has
caused its corporate seal to be hereunto affixed and these presents to be subscribed by
a majority of the said Board of Trustees, the day and year above written.
seal ........ S.)
............................................................ (L. S.)
STATE OF NEM/ YORK )
SS:
COUNTY OF SUFFOLK )
THIS.......~...7 ........ day of .......~.e...~'....~....a~.~t ............................... , 19....~...1., before me
ON
personally ~ared ~on~ ~, of ~~, ~.Y. ~ ~=n~ ~on,
~ieRt~ ~ ~ AlV~ ~ld~i~ Of ~0[~, ~oJJ personally known
to me, who, being by me duly sworn, severally said that ~hey each resided in the Town
of Southold, Coun~ of Suffolk, State of New York, and were members of the Board of
Trustees of said Town of SouthoJd and constituted a majority of the ~me; 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 fha
B~rd of Trustees of said To~ of Southold and that each one signed his name thereto os
~ Trustee and by like order.
............
~oto~ Public
Oomm;~sion ~xg~e~ ~arc~ 30,
TOWN OF SOUTHOLD ,..,A } b
80ARD OF TOWN TRUSTEES ~ ~
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
D~s~pprove~/c ~~- .......................................................................................
~ APPLICATION FOR PER~IT
A. This application ~o be completely fi~ed in by type~iter or m i~ and sub~tted to the To~ ~stees ~ dup-
licate.
B. P]~ plan showing Ioc~tion of lot and buildings on premises, relatiom ~o a~o~ing pre~ses, pub~c~ s~e~ts,
parks, e~c., ~d giving det~e~ description of prcpcaed l~yout of pro~ect m~t be ~awn o~ dia~am which is pa~ of
this application.
C. The work covered by this ~ppbcation may no% be commenced before the issuance of ~ permit.
D. Upon approv~ of ~s application, Town Trustees ~ ~ssue a permit to app5cant. ~uch per~% sh~ be ke~t
on the presses and ~v~flable for ~spection at a~ times.
E. Applicant shah notify the Board of ~ustees upon ~. -~
~om~et~on of ~he wc~k ~overed by per.t,
APPLICATION IS HEREBY MADE to the Bo~d of ~stees of the Town of Sol, hold, Suffolk Oo~ty, New York,
for ~he issuance of ~ per~t p~suant to the laws, Or~anoes and r~g~ations gove~ing oonst~c$iom of: docks.
pzers, bul~eads. ~ettys and dred~ng ~; under, and over the waters of Town of So~thold. ~e applicant a~ees
to comply ~th aH applicable laws, erd~smces, relations aad conditions specified by s.aid trustees, aad
the Town ef Southcld. and aR Town o~cia]s free from liabi~%y and damages of any ~d.
Name of o~er of premises ---~----~S~ ....................................................................................................................................................................................
Home address If Other ~aa Location ........ ~_ .........................................................................................................................................
Creek, Bay or Harbor Fronting Property ~a~-----~eek .....................................................................................................................
$~e of Proposed ~ork: Len~h _.~.~ ................ %~;idth _~.~-.... Heighth ABove ~gh Water ----a~--.-~
Deptk Below Low Water ...~_.~ Average Rise In Tide ....... ~ .............. Yards to Be ~cavated ......~-~
~idth of Canal, ~feek o~ Bay Fro~ing Property ..... -~t--pt~ .. Depth at Low ~de ....
Complete plot plan to be dra~ on reverse side of this app~cation.
~$ app!ieation is to reeovem soil t~t has ~een ~ash~ out ~
storm d~age.
STATE OF NEW YORK)
)S.S.
COUNTY OF )
~../..~.~.~... duly depsses and says that he is the applicant for the above de-
sc~d~"~7~pc~mit, an.d~that~ ~a~ statements contained here~ ~e true to the best of his knowledge and belief; thst the
~ork will be done in the manner set fo~h in the application and as approved by the Board 9~ Trustees of the Town
of So.uthold~ ~md the applicant agrees %~ hold the To~ of Southold and said trustees harm~,~s and free from any
and ~ damages and claims a~smg under or by vi~ue of s~d per~.
~ } ~ (app~cant) ~ '
Swo~ to before me t~s ...... ~..~$ ........... day of~..~... 19.~