HomeMy WebLinkAboutNOOR, HANS & MARY
FOEI~ NO. 1
TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ........................................ I9 ............ Application No ...............................
Approved ................................................................................ Permit No ......................................
Disapproved a/c .......................................................................................................................................................................
................................................................................ chairman, Board of Trustees
APPLICATION FOR PERMIT
INSTRUGTIONS
A. This application to be completely filled in by typewriter or in ink and submitted to the Town Trustees ir~ duplicate.
B. Plot 21an showing [ocation 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 ori, diagram which is part of this appli-
cation.
C. The work covered by this application may not be commenced before the issuance of a permit.
D. Upon, approval of this application~ Town Trustees will ~ssue a permit to applicant, Such permit shall be kept on the
premises and available for inspection at ell times.
E. Applicant shall notify the Board of Truslees upon 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
~ssuance of 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 to comply with all appli-
cable laws, ordinances, regulations and conditions specified by said trustees, and to hold the Town, of Southold, and oil
Town officials free from liability and damages of any kind.
Street Address of Property ...... ~e~t...C~e~c..A.~ze.,..t..~fe~t..~oa~.~...C.ut;~.ha¥~ ..................................................
Creek, Bby or Ha~bor Fronting Property ...~*kh~!.s...C~.e~k .......................................................................................
Size of Proposed Work: Length ...2.~)~).0.: .............. Width ....... ].OD.: ............. Heighth Above High Water ...........................
Depth Below Low Water ......... Z2.~. .......... Average Rise In Tide ....... ..q:..: .............. Yards To Be Excavated ..........................
Width of Ca~al, Creek or Bay Fronting Property .......................................... Depth at Low Tide ..........................................
Is This For Private or Business Use? ......~a&~e~ .............................. Area Zoning ............... ~ .....................................
Complete plot plan to be draw~ on reverse side of this application.
STATE OF NEW YORK)
count' s.s.
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 Southold and said trustees harmless and free from any and all damages and claims
arising under or by virtue of said permit. ~ __
(applicant)
Sworn to before me. this ..... ,~, f~.. day of