HomeMy WebLinkAboutMUDD, DAVID & BETTY JANETown Trus~ee~
FOR1M[ NO. 1
TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined .............................. 19 ...... Application No ..................
Approved ............................................ Permit No .............................
Disapproved a/c ................................................................. ' ............................
..................................................... 2. chairman, Board of Trustees
APPLICATION FOR PERMIT
INSTRUCTIONS
A. This application to be completely filled in by typewriter or in ink and submitted to the Town Trustees in dup-
licate.
B. Plot plan showing location of lot and buildings on premises, relation to adjoining premises, public streets,
parks, etc., and giving detailed description of proposed layout of project must be drawn on diagram which is part
of this application.
C. The work covered by this application r~ay not be commenced before the issuance of a permit.
D. Upon approval of this application, Town Trustees will issue a permit co applicant. Such permit shall be kept
on the premises and available for inspection ar all times.
E. Applicant shall notify the Board of Trustees upon completion of the work covered by permit.
APPLICATION I8 HEREBY MADE to the Board of Trustees of the Town of Southold, Suffolk County, New
York, ~or the issuance o~ a permit pursuant to the laws. Ordinances and regulations governing construction of: docks,
piers, bulkheads, jettys and dredging in, under, and over the waters of Town of Southold. The applicant agrees
ro comply with all applicable laws. ordinances, regulations and conditions specified by said trustees, and to hold
the Town o~ Southold, and all Town qfficials free from ligbility and d~ages of any klnd. ~ X
~-~m~ o~ ow~ o~ p~ ..~.~.~...g:. q g~ T~7 ~ ~ ~ ~ ~
Home address I~ Other Than Location ..... ~ ................................................................
Creek Bay or Harbor Fro~ting ProperS, .... ~. ~ .¢. (~.~.~-- ...... ~. ~.~ ~.~ ..................................
Permit Requested To: ... ~..Q. ~ [~...;
Size of Proposed Work: Length ..... ~ .Q..~ ....... Width....~. / .... Heighth Above High Water... B '
Depth Below Low Water .... ~. ~
.......... Average Rise In Tide .... ~./ ....... Yards to Be Excavated.
Width of Canal, Creek or Bay Fronting Proper~y ..... ~/...~ ~..Depth at Low Tide .....................
~s This For Private or Business Use? ..~.~.~,~. ~ ~ ................ Area Zoning ...........
Complete plot plan ro be drawn on reverse side of this application.
STATE 017 NEW YORK )
)s.s.
COUNTY OF.~.~)
...~...~. ~.~. ~ ,~... being duly sworn deposes and says that he is the applicant for the above de-
scribed permit, and that all statements contained herein are true to the best of his knowledge and belief; that the
work will be done in the manner set forth 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 Southotd and said trustees harmless and free from any
of said p~nit. ~ ~ ,~
and all damages and claims arising under or by virtue ~
....... .............. . ......... ........ ......
(applicant)
Sworn to before me this..., .°~. ~ f~...day o£..~ ..... 19.~...Z~...