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HomeMy WebLinkAboutMOY, DAI iea~eo :iOnapp tablad., ; e Board of T°wn T~usteeS waiveS °bjec%i°n t .Th 2.2j 2fla CUlkhead On the property ~ Lak~ Drive, Lon ix= ~ ~ at East ~ . · n i ~ Park,: s~UghOld, Hew~ ~0rk'~ 2C?~t~° is 6n.~ basih whiCh:~is an .znien ~ .... lkhead; : repla above of tb'le~o ,iS com below accord els t Fee: tic Fee, Total Fee fcr this application:-- '' Si ~rusEees. b Secretary- ~ _.~ BO~RD OF SOUTHOLD TOJN TRUSTEES A/3 rev/O 72 APPLICATION p©.. q BU~_K_~AD, D~K;~., OR l~'r~v Does this pro]ecE involve the use of WETI~%NDS as defined in Ehe Southold 'r '~ . ~o~m ~etlands Ordinance? ~NO If it does, you muse file tnrouoh the To~ Clerk's Office o Is the proposed work entirely within the boundaries of your properny as substantiated by your Deed or Survey? YES or NO, If it ~s, a Permit is NOT required from this Board, but the Towm Building Inspector should be contacted for full details. 3o Applicant's name & address: Mr. Daio~ , · 37 Mort Street_~New York, New York (gas~ Lake Dr.. Southg_l_d~ Contractor'S name & address:__ Ralph ~, P~e~ton~ ~te~tre ~g44 5. ~xplain briefly the purpose of this application: _ .To sto~ erg$ion of ~,~ners__]~ropgr~ty__a_n~top fill channel leading_to baBin. After zssuance of Fe_mit, I exoect co: (mark with an X) Afte~ gettin~ (a ~ Commence work ..... AT ONCE ; ASAP_x_; uN~ANO~N TI,.~ . 90 ~FS after s~art. (b) Complete work in--1DAY ; 1MO...._; tYR. _; ~UTURE_x_. Secu_e t e correct Are~ .,ap from tn~ Secre£ary of ,is ~oar o¥ usLng an X JI%HIN A CIRCLE as a mark, hnd_cate as close~u possible the location b~ this pro]eCgo On the reverse provide a SCA_ ~E DRA_ ~ING which will show Ordinary HiRh Water ~rk as weit as the size and shape of the structure or work to be done. Also include all dimensions for portions which extend o~fshore from the ,~.H,~ Provide (a) the following documents: A Licensed Engineer's Survey Of the pr,operty involved. A copy of the Contractors Plans & SDecificauions, Does %h~s projecn extend into Town Waters beyond an imaginary line or boundary formed by exist~g work's of a similar nature along this area~s shoreline? YES or NO~ If it does, staue phe approximate distance beyond. NO fro I0. Will 'this construction require the Filling of any land offshore of the Ordinary High Water ~ark ~or the Dred~ging of-any matarzal from Town Lands under water.~ Y°E~ or NO. ~f it does, Form A/4 (A2plication f~r Dredging/Fillin~ mush be completed and au[aci~ed as part of this application° 11. In requesting approval of this application, I submit that: the informiiCion presented hereLn is true and correct, to the best of my knowledge and belief: I am the person accouhtable for the performance of~the work in accordance with the plans and spec- ifications attached; I have ~ead or am familiar wiuh the visions of ~any Southold Town Ordinance pertinent ~o the work invdlved; and~furcher,I intend to adhere f6 and abide by the Ierms and ~ondlt~ons of the Permzt,when ~d if Issu~ [o XX,(XX~KXKXXX XXX ~KXX XL%{ XXX XXXXXXXX~~~X~{~X~XXKK;~XX ;c~}¢t Accepted b~ ~ ,// Dated:~.~ Lc, cu,.~-...L'