HomeMy WebLinkAboutTR-4179 GFBOard Of $outhold' Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. ~ 1 ? ~.
DATE: .....5/2 6/9.3
ISSUED TO ....... SAMU.~L..P.,....PR~L~IT~ ............
u horiza o
Pursuant fo 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 ..5/.26/93
19...93, 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:
Grandfather Permit to replace 295' of existing bulkhead
in-kind/inplace. Backfill with clean fill (approx 150 c.y.)
Peconic Bay.
all in accordance with fha detailed specifications as presented in
the originating app)ication.
be Subscribed by a majority of
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to
Board as of this daf, e.
John M- Bred ,e~,. eyer, III, President
Henry p. Smith, Vice President
Albert1. Krupgki, Jr.
John L Bednos~k!, .Ir
~ lohfi B~,Tuthfll/-
SUPERVISOR
SCOTF L tlARRIS
Town Hall
53095 Main Road
P.O, Box1179
BOARD OF TOWN TRUSTEES Southold, New York 1 t971
TOWN OF SOUI~OLD
COASTA5 EROSION MANAGEMENTPERMIT APPLICATION
TOWN WETLANDS PERMIT APPLICATION
~:TRUSTEE LANDS PERMIT APPLICATION
Office Use Only:
Permit Application
Application
is. Date:
Required,
notified Date:
Dpt.,mand.
/date: ~-2~
/date:
Date Rec.
by Office
Vote: (Y/NI:
Dns:
.(a!so see fileJ
Application Fee:
ApPl%~a~ Number; ..SCTM ~lO00-
Dat~,~repgred: . q_o~7_q.
Address:
Interest:
Subj e~t' pr0perty Location: in U ~; A~ h/~E(~ k~ k~ r_
'iProvide LILCo Pole ~, Distance to cross Streets if not on
location map~
Phone {~6) ~9q-iIq9
( owner, consultant, lessee, etc. ) .~ ~ ~ ~ T
THIS IS NOT A PERMIT
Yds. to be excavated: Yds. to be filled:
Manner in which material will be removed or deposited:__
Width of canal, cre~k or bay fronting property:
Depth at low tide: ~ aver~ rise in tide:
Distance to nearest channel: ~/~ Distance ~roject
extends beyond similar projects in area:
Area zoning:.~ ~ ~5~A~Land area in acres: ~ ~
Is pro]ec~ for pr. ivate or business use:
Intended use of property: ~%t~ ~ ~!b~
Describe known prior operations conducted on premises:
Has any prior license or permit been issued to erect structures~
dredge, or deposit fill on said premises:
Has any license or permit ever been revoked or suspended by a
Governmental Agency: ~ ~
Project Description
The project description must also include plans for reclamation
of land disturbed during construction of the principle and
accessory structures and underground structures (ioe~ 'pipe!ine
and septic system; make additional attachments if necessary)~
Authorization '%Where the app!ic not the owner)
I residing at
(Print-owner of subject property) (Mailing,!~ddress-phone)
do hereby authorize to apply for
Coastal Erosion permit(s) from the Southold Town Trustees
Signature
THIS IS NOT A PERMIT
county of Suffolk )
state of New York )
~E~E ~ C~ST~O. ~ BEING DULY SWORN DEPOSES AND
AFFIRMS THAT RE/SHE IS THE ~PPL~CANT FOR THE ABOVE DESCRIBED
PERMIT[S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO
THE BEST OF BIS/HER KNOWLEDGE AND BELIEF, AND THAT WORK WILL BE
DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE
APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES
HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMITIS), IF GRANTED.
IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,
THEIR AGENT[s) OR REPRESENTATIVE(s), TO ENTER ONTO MY PROPERTY
TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS
APPLICATION.
SWORN TO BEFORE ME THIS
SrGNATURE
OF _A _,
NOTARY PUBLIC ~
Suggested space for location Map
THIS IS NOT A PERMIT
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