HomeMy WebLinkAboutTR-345 TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
PER~IT NO ....................
Pursuant to the provisions of Chapter 615 of the Laws af 1.893 of the State of
New York and Chapter 404 of the Laws of 1952 of the State of New York and in accordance
with the .resolution of the Board of Trustees of the Town of Southold adopted at a meeting
of said Board on .......... ~D, eL~,....3.~ ........................ and ia consideration of the sum of
$.-.~.k~.J., I~ful money of the United States, ~id by....~.~ ~ .....................
residing at ..... ....~..~...~,..~ ............................. ~, New York,
the said Bgord of Trustees of the Town of Southold, Suffolk COUp, ;New York, hereby
authorizes and permits said; ....... ~..~SS~ ......................................................... to
e~e~ l~resen~ d~k 1~ fee~ i~ Jockey ~, all in
a~ w~h ~he &~l~a~i~ mubmitte~.
The said .......... .~...o.?..,e.~..~..s...~.. ............................... , os part of the consideration
for the issuance of this permit does hereby release the said Board of Trustees and the
Town of Southold from any and all damages, claims for damages or suits that may arise or
occur directly or indirectly as a result of any operation :arried on under and pursuant to this
permit, and will at his own expense, defend any and all suits which may be brought by third
parties as a result of any operation carried on pursuant toor in accordance with the terms of
this permit, and assume full liability with respect thereto to the complete exclusion of
said Board of Trustees and the Town of Southold.
THIS PERMIT is 'subject to the following terms and conditions:
1. That there shall be no unreasonable interference with navigc~on as a resul$ of the
work herein authorized.
2. That there shall be no interference with the right of the public to pass and repass
along that portion of the beach between low and high water mark.
3. That the work shall be subject to the supervision and approval Of the said Board of
Trustees or its agents,
IN WITNESS WHEREOF, the said Beard of Trustees of the Town of Southold has
caused its corporate seal to be hereunto affixed and these presents to be subscribed by
o majority of the said Bo~rd of Trustees, the day and yegr above written.
.... ~f~i.(L. S.)
STATE OF NEW YORK )
SS:
COUNTY OF SUFFOLK )
ON THIS......~...~..~. ....... day of ................... ~.~...~[~ ............................ 191~..~..., before me
personaJ y appeared ~ B. G~.L~, ~¢~ ~.m~, ~::~ F.
~=N~LCy, Frank ~w~ am~ D(~,glas R~ber~,
all personally known
to me, who, being by me duly sworn, severally said th0f ,hey 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 o majority of the same; that they
knew the corporate seal of said Town of 5outhold; that the seal affixed to the 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.
~[m ~pir~s March 30, 19~e~7
Notary Public
FORM NO. 1
TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Application No ................ ;.
t .................. .~., ........................ Permit No ....... .~..g/-.~--~. .............
teeSAPPLICATiON;;. FOR gERMIT
INSTR/UCTIONS
A. This application to be completely filled in by typewriter or in ink and submitted to the Town Trustees iff ~up-
licate.
B. Plot plan showing location of I0t~and bu'il/ii'ng~'on premises relation to adjoining premises, public streets,
parks, etc., and giving detailed ~c~escription of proposed layout of project,must be drasx/n on diagram ~¢hich is part
of this application.
C. The work covered by this application may not be cdmmenced before the issuance of a permit.
D. Upon approval of this application, Town Trustees will issue a permit ro applicant. Such permit shall be kept
on the premises and ava;ilable for inspection at all times.
E. Applidant shMi notify the Board of ,Tgust~es upo~n ~ompletmn of the work covered by permit.
APPLICATION IS HEREBY MADE to the Board o,f Trustees of the Town of Southold, Suffolk County, New
York, for the issuance of a permit pursuant to the laws, Ordinances and reffulatinns *overninff construction of: docks,
piers, bull/heads, jettys and dredging in, under, and over the waters of Town o~ Southold. The applicant agrees
to comply with ail applicable laws, ordinances, re~la~bns and couditions specified by said trustees, and to hold
the To~m of ~fi, uthold, and all Town officials free from liability and damages of any kind,
of owner of rem~ses ~~-- ~--~ ~ ~
Name
Srree~ Address of Property .~.~.~.~,~,~.~.~ .... ~.~(F~.~ ......
Home address If_ .Other,-- Than Location ~/...~,. ;~:.~g -~ O; ~-~ ag~* [~ ~ ~&~ ~'-~7
Creek, Ba or Harbor Frontm' Pro err~ ~'~~ ~ ~.~
y g p y ..~--'..,,n_ .... ~ ..... ; .......... , ........................
to: . ...................................................................
S~ze of Proposed Work: Len~h... i.~ A >. ~ .... W~dth. ~..~ ~.~...Heaghth Above High Water. ~.
Depth Below Low Water.. ~ .U.~ [~Average Rise In Tide ~. ~SeS{'~ards to Be Excavated ....
Width of Canal. Cree~, Or B~Frdntififf Property ..................... Dep~ at'Ow, Tide ......................
Is This For Private or Busines~ Use? i~ t.~.T~ .... [ ................ Area Zoning ..........................
Complete plot plan to be drawn on reverse side of this application.
~-~.-, STATE OF NEW YORK )
COUNTY OF )
....... b~ng duly sworn deposes and says tl~at he ~s the apphcant ~or the above
~c~ed p~rmit, and that ~11 sfatements contained herein are ~ue to the besfi of h~s knowledge and belief; that the
~rk will be done in the mann~ set forth in the ~pplication and as approved by ihe Board of Trustees of the Town
o{ Southold. and the applicant agrees to hold the Town of Southold and said ~rustees harmless ~nd ftee fro~
&nd ail damages ~nd claims amsin~ under or by wi~tue 6~ sa~d
Sworn ro bef~e me thls..,~.~ ...... day of. ,.,~2~.~::... 19.
--- NOTARY pcgtlC, State ~, N~
~o. 52-3233120 Suf,ol~
Term ~p]res m~rch 30,