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HomeMy WebLinkAboutPOWER, WILLIAM JR.W Ld L~ 0 0 < 0 d 0 4~ 0 ~4 0 0 .p 0 r0 ,..q 0 4.1 0 The authority conferred by this permit may be terminated by the Board of Trustees for a failure on the part of the said ............... ..~..~.~..]...:J:.~..m....?..o..~...e..~..~.~.~:. ............................ to comply with the terms and conditions herein imposed. In the event of such termination, this permit shall be deemed revoked five (5) days after the date when the Board of Trustees shall mail to the said .......... .~...~..~.]:.~.~..m....?..o..~...e.?...~....~?..:. .............................. at the address given in his application, a certified copy of a resolution of the Board of Trustees directing such termination. 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 year above written. seal ....... ;L..~. (L. S.) ...... (L. S.) STATE OF NEW YORK COUNTY OF SUFFOLK 8th - , - JUNE ON THIS .................... 007 o~ .................................................... , 19..7..9..., before me ~ersonallyappeared Alvah B. Goldsmith, Frank Dawson, George Simpson, John F. McNulty and Douglas Robertson, oil personally known to me, who, being by me duly sworn, severol!y said that they each resided in the Town of Southold, County of Suffolk, State of New York, and were members of the Board of Trustees of said Town of Southold and constituted a majority of the same; that they knew the corporate seal of said Town of Southoid; that the seal affixed to thc foregoing instrument was such corporate seal; that it was so affixed thereunto by order of the Board of Trustees of said Town of Southold and that each one signed his name thereto as a Trustee and by like order. Fi~ed: Notary Public NO. 1 TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined 19 Application No ................... Approved ......................... Permit No ............................. APPLICATION FOR PERMIT INSTRUCTIONS A. This application to be completely filled in by typewriter or in ink and submitted to the Town Trus'tees in dup- licate. B. Plot plan showing location of lot and buildings on premises, relation to adjoining premises, public streets, parks, etc., and gS¥ing detailed description of proposed layout of project must be drawn on diagram which is part of this application. C. The work covered by this applicatiox~ may not be commenced before the issuance of a permit. D. Upon approval of this application, Town Trustees will issue a permit to applicant. Such permit shall be kept ou the premises and available for inspection at ali times. E. Applicant shall notify the Board of Trustees upon completion of the w-ork covered by permit APPLICATION IS HEREBY 3v~ADE 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 in, under, and over the w~ters of Town of Southold. The applicant agrees to comply wvith ail applicable laws, ordinances, regulations and conditions specified by said trustees, and to hold the Town of Southold, and all Town officials free from liability and damages of any kind. Name of Owner of Premises.. :.~..~..'...~..~./~..~..~./ ................ ........................................ Street Address of Property .~'.~./t~..~.~. ..... .?.~..~...~..~..~.:~ Home Address If Other Than Location ....................................................................... Creek, Bay or Harbor Fronting,~ ', ~_ ~- . ~ , '~ ~ - ~,Pr°perty' .~~ ~.~-P_~.~ ....... . ............................... Permits e,ues ed To:- ...................... · 7~/~ ~ .~,~/ .~ . Width of Canal, Creek or Bay Fronting Property ....... ~ ............. Depth at Low Tide ~.~...~ ......... Is This For Private or Business Use? ..... ~.~ ............... Area Zoning . .f.--~....~ Complete pl~t plan to be drawn on reverse side of this application. STATE OF NEW YORK ) )s.s. COUNTY 'OF ) · .~.°.'.'.'.'.''~ ~'"''"' being duly sworn deposes and says that he is the applicani for the above described permit, and 'that all statements contained herein arc true to the best of his kno%vledgc and belief; that the work will be done in /he 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 sa£d trustees harmless and free from any and ail damages and claims arising under or by virtue of said permiT.