HomeMy WebLinkAboutTR-10-5-13.3Board Of Southold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. 10-5-13.3
DATE: ....3/11/~3
ISSUED TO ......Q~F NELSON ...........
Pursuant to the provisions of Chapter 615 of the Laws of
the S~'a+e of New York, 1593; and Chapter 404 of the Laws of the
State of New York 1952; and the Southold Town Ordinance en-
titled "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and +he
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance wlfh the
Resolution of The Board adopted a+ a meeting held on 2/.25
19 .~5, and in consideration of ~'he sum of $ paid by
of ......................................................... N. Y. and subject ~o the
Terms and Condiflons listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits '~he following:
Fill 90' X 12' with clean sand, Located Private Road,
Fishers Island.
all in accordance with the detailed specifications as presented in
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal +o be affixed, and these presents to
be subscribed by a majority of.fl~ said Board as of +his da~'le.
TRUSTEES
John M. Bredemeyer. III. President
Albert J. KrupskL Jr.. 'Vice President
Henry E Smith
John B. Tuthill
William G. Albenson
TelePhone (516) 765-1892
Fax (516) 765W823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
SUPERVISOR
SCOTT L. HARRIS
Town Hall
53095 Main Road
RO. Box 1179
Soutl~old. New York' 11971
COASTAL EROSION MANAGEMENT PEP~IT APPLICATION
TOWN WETLANDS PERMIT APPLICATION
TRUSTEE LANDS PERMIT APPLICATION
Office Use Only:
~Coastal Erosion Permit Application~
~%Wetland Permit Application J
~Waiver from Chapter'97
~qTruStee Lands Permit Application
~%Grandfather
~Completed Apps. Date:
_~CAC comments-Date: Sent__Rec.
~Variance Required,
Neighbors notified Date:
SEQRA Type ~
Coord. Review-opu.,mand.
Insp. comp./date:
__SEQRA Determin./date:
Public Hearing/date: Findings:
Permit Vote: (Y/N):
Special Conditions:
(also see file)
OLF
Date Rec. by Office
Application Fee: ~,~°
Application Number; SCTM
Project Name (If any).
Interest: (owner, consultant,lessee,etc.
Owner of Prope~rt~: Oi~--~ ~'~[~.~_qC::~"L
Address ~ ~ ~DM~.
(~~ ~ ~ Phone C~l~ ) ~--~
Subject Property Location: ~¢J~. ~eF~~
(Provide LILCO Pole
location map)
Distance to cross Streets if not on
Page 1
Yds. to be excavated: ~ Yds. to be filled:
Manner in which material will be removed or deposited:
Width of canal, creek or bay fronting property:
Depth at low tide: ~f~ ' .Aver. rise in tide: ~
Distance to nearest Channel. ~o~ ' Distanc~ p~ojeet
extends beyond similar projects~in area: ~t~ ~
Area zoning: ~ Land area in acres: ~/~
Is project for private or business use:
Intended use of property: ~w~f~ ~~,~/~
Describe known p~ior operations~c~ndt~¢d %n p~.emzses~
Has any prior license or pe~ been ~ssued to erect structures,
dredge, or deposit fill on-said premises:
Has any license or permit ever bee~ revoked or suspended bY a
Governraental Agency: '~k~t~ w,c~_~% ~%1~
.pro)ect Description
The project description must also include plans for reclamation
of land disturbed during construction of the principle and
accessory structures and underground structures (i.eo, pipeline
and septic system; make additional attachments if necessary).
Authorization (Where the applicant is not the owner)
I residing at
(Print-owner of subject property) (Mailing address-phone)
do hereby authorize to apply for
Coastal Erosion permit(s) from the Southold Town Trustees
Signature
THIS IS NOT A PERMIT Page 2