HomeMy WebLinkAboutTR-E 70-4-46.1 GFBoard Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. '£ .].~'~:'~/~'J
DATE:
ISSUED
TO
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uthorizat on
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893; 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 the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance with the
Resolution of The Board adopted at a meeting held on
19 and in consideration of the sum of $.£'~:~? paid by
of ................................... N. Y. and subiect to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
all in accordance with the detailed specifications as pre~nfed in
+he orlginafing applicaHon.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes ifs Corporate Seal to be affixed, and these presents fo
be subscribed by a maiorlty of the said Board as of this da~e.
Trustees
TRUSTEES
John M. Bredemeyer, III. President
Henry P. Smith. Vice President
Albert J. Krupski, Jr.
John L. Bednoski, Jr.
John B. Tuthill
Telephone (516) 765-1892
BOARD OF TOWN TRUSTEES
TOWN OP SOUTHOLD
SCOTt L. HARRIS
Supervisor
Town Hall. 53095 Main Road
P.O. Box 1179
Southold. New York 11971
,Fax (516) 765-1823
Telephone (516) 765-1800
GRANDFATHER APPLICATION
Name of Applicant:~~.~t~
Address of
Tel. No: (~[-~- L~-~-~:/-eO%
Property: 7_~OC ~k V~-~ ~k-~-~
Tax Map Number: 1000-]~3-%~[~. \ Approx.yr.of construct:~%kh~.~
Prior owner if known: ~-~t~
Diagram of existing structures, including all dimensions,
included with this application:
must be
Indicate on attached map:
pole number,
Signature of
Please note,
application.
Location, ie; reference point, telephone
adjacent property ow~, etc.
applicant: X~\I~,~ ~ Date: ~-~-7 [~'7_..
there is a one time fee of $50.00 for filing this