HomeMy WebLinkAboutTR-278 TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
PEI~MIT NO......~,~, .........
Pursuant to the provisions of Chapter 6]5 of the Laws of ]893 of the State of
New York and Chapter 404 of the Lows of 1952 of the State ef New York ~nd in accordance
with the resolution of the Board of Trustees of the Town of Soathald adopted at a meeting
of said Board on ....... ~.~..~,...~,~ ....................... and?n consideration of the sum of
$..~,~,, lawful money of the United States, paid by..
residing at ....... ~..~l~...~~..~,~, ......................................... , New York,
the said Board of Trustees of the Town of Southold, Suffolk County, New York, hereby
authorizes end permits said...~..~..~..,~..~..~..~o
The said~.~...~m..~m...~..~...~/~...~he consideration
for the issuance of this permit does hereby release the said Board of Trustees and the.
Town.of Southold from any and all damages, claims for damages or suits that may arise or
occur directly or indirectly as o result of any operation carried on Under and pursuant to this
permit, and will at his own expense, defend any and all suits which may be brought by third
partie~' as 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 and the Town of Southold.
THIS PERMIT is subjfct to the following terms'an(~ conditions:
1. That there shall be no unreasonable interference with navigation as o 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 low crud high water mark.
3. That'the woit~ shall be subject to the supervision and approval of the said' Baa'rd 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 y~ar above wdtten;
seal ........................................................ (L S.)
(L.
S.)
...... ,-' ... .Gl-. S.)
STATE OF NEW YORK )
SS:
COUNTY OF SUFFOLK
ON THIS.....~4~J~t......day of ........... ~.~. ...................... .............. lg,.~, before me
personally appeared ~
aH per~nally ~own
to me~ who, being by me duly sworn, severally said that they each resided in the Town
of Southold, Cou~W of Suffolk, State of New York, and were members of the Board of
Trustees of said Town of Southold and constituted ~ majori~ of the some; that they
knew the corporate seal of said Town of Southotd, 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 ~uthold and that each one signed .his' nome thereto ~s
a Trustee and by like order.
/~ & ~ Noto~ Public
T~m Ex~ires March 30, 15~
TOWN OF SOUTHOLD (~~/.~~ ~/
BOARD OF TOWN TRUSTEES ~},) .t
TOWN CLERK'S OFFICE (~~ ,,~_,;~/__~/~
SOUTHOLD, N. Y.
......... ^pp,,cation .............
Examined
Approved ................................................................................ Permit No ................ ~ ....... ; ...........
ppr ,ed .............................. ....................................................................... ..............
........................ ~..~.~ .......... chairman, Board of Trustees ~ ~ ~
APPLICATION FOR PERMIT
INSTRUCTIONS
A. This application to be completely filled in by typewriter or m ink and submitted to the Town Trustees in duplicate.
B. Plot plan showing location of lot and buildings on premises, relation to adjoining premises, public streets, porks, etc.,
and g~ving detailed description of proposed layout of proje~ct must be drawn on diagram which is part of this appli-
cation.
C. The work covered by this application may not be commenced before the issuance of o permit.
D. Upon, approval of this application, Town Trustees will ~ssue a permit to applicant. Such permit she be kept on the
premises and available far inspection at a,ll times.
E. Applicant shall notify the Board of Trustees uoon completion of the work covered by permit.
APPLICATION IS HEREBY MADE to the Board of Trustees of the Town of Southold, Suffolk County, New York, for the
issuance of a permit pursuant to the laws, ordinances and regulations governing construction of: docks, piers, bulkheads,
jettys and dredging m; under, and over the waters of Town of Southold. The applicant agrees to comply with all appli-
cable laws, ordinances, regulations and conditions specified by said truste~es a.nd to hold the Zowr~ of So~t~.'d,
Town officials free from Ii ability end damagesof any kind.
Name of owner of premises ....~.[-~.¢...q,:..[P..~..e....C~..3~T~,...~Sa~...~..~..Zi-t~e~ba~eb, .............
Street Address of Property ]~y View SO~;hO1C]~
Home Address If Other Than Location .....................................................................................................................................
Creek, Bay or Harbor Fronting Property ...... .~..~.?.~ ..............................................................................................................
Permit Requested To: Dz'ec~ge
Size of Proposed Work: Length ~00 Fi Width 50 ~ Heighth Above High vva r ..........................
......................................................... . "'re
Depth Below Low Water ~ Fi Average Rise In Tide . 3 ~ Yards To Be Excavated ...~.5...q.0. ..............
Width of Canal~ Creek or Bay Fronting Pr92e.rty ....O..9..z'..z:..e.~..~....O.~.e..~..~. ......... Depth at Low Tide ..~.0~. ...................
,, p F~iV~ -. ...........
Is This Par Private or Business use ......................................................... ~ree Aoning ............
Complete plot plan to be drawn on reverse side of this application.
STATE OF NEW YORK)
S.S,
oF
. -
permit, ana 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 0f Trustees of the Town of Sou.thold, and the
applican,t agrees to hold the Town of Southold and sold trustees harmless and frae from any and all damagea and claims
arising under or by virtue of said permit.
..............
{oppii~ont~
Sworn to before me this .....