HomeMy WebLinkAboutTR-956BOard Of Southold Town Trustees
~soiJTHOLD, NEW YORK
PERMIT NO. ' /" ' DATE:' June ~i
Pur$~anf fo fha ~f Chapfer 615 o~'
the Sta~ of New ' and ~a
State O~ New Yor~
f~e~ "'REGULATING AND THE PLACING OF OBSTRUCTION5
IN AND ON TOWN WATERS AND PUBLIC LAN~ en~
~ 5AND, GRAVEL OR,OTHER
and i~ accordance with'the
Resolafion at a meeting held
........... ~H~ and
~0~ +ha reverse
eu~ha~zes ~nd permlfs
[lda ft.~ dock
, With two
~f Pine
~affixed, and these
said Board es of.
TERMS ~d C4DNDITIONS
~ T~e ~ Edward Robedee
ac 1935 Pine Tree Road, Cutchoque
part of the Consideratio~ for ~ h~e Of ~e Pe~t d~
BO~RD OF $OUTHOLD TOWN TRUSTEES
/'72
APPLICATION FOR FIXED and/or FLOATI~.~,~.DOCKS ,~-
t. Applicant's name & address: /~'j ~,~
~'~. Con~ractor's name & address:
After issuance of a Permit, I expect to: ('mark by an X)
(a) Commence work ..... AT ONCE_~/; ASAP__; UN~LNOWN__.
(b) Complete work in-~iDAY ; 1MO. ; l~. ; FUTURE__.
5, Secure the correct Area Map from the Secretary of this Board,and
by using an X WITHIN A CIRCLE indicate as closely as possible the
location of this dock. On the reverse side of this map~ provide
a SCALE DRAWING which will show Ordinary High Water Markj the shape
and size of the dock and any supplemental pilings which are needed
to hold a floating dock or tie-up a boat. Give all dimensions
nec%ssary to determine the area of the dock-surface which ex~ends
off~<hore from the O.H.W.M.
6. Will any portion of this construction extend offsho~re into
Waters beyond an imaginary line or boundary formed by other
similar structures along the area's shoreline? ~or NO. If it
does extend beyond this so-called dock lithe indicate by how
far, approx imat ely, __~if t.
7. Provide the followinm documents:
(a) A Licensed Engineer's Survey of the property involved,
(b) A copy of the Contractor's Plans & Specifications.
Will this construction require the Filling of any land offshore
of the Ordinary High Wa~er Mark or the Dredging of any material
from To~a Lands under water? ~r NO. If it does, Form A/4
(Application for Dredging/Filling) must be :~completed and attached
as part of this application.
9. In requesting approval of this application, I ~it that: ~he
information presented herein is true and correc~ to the best of
my knowledge and belief; ! am the person accountable for the
performance of the work in accordance with the plans and spec-
ifications attached ; I have read or am familiar with the pro-
visions of any Southold Town Ordinance pertinent to the work
involved; and further,I intend to adhere~to and abide by the
Terms and Conditions of the Perm,, when and~/i~f~ issued ~o me.
XXYD( _SLX XXXXX XXXX XX~Y. Xfz_Y.X X XXXX ~ ~ ~ 3,..x~ .x~i_,v,x z.~ XXY, LK XX XX X X_~Y~ XXXJYb(- X X XX X XXXXXX
Accepted by: Dated: