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HomeMy WebLinkAboutROGALSKI, STANBOARD OF TOWN TRUSTEES Town of Southold l~ain Road Southold, New York 11971 To: Stan Rogalski 1. Your application, dated ....... ~...L~...e.....1...b?..~.....]:.?..7...8.. ................................. has been reviewed by this Board, at a meeting of the Trustees held on ...... .4u.~...5, . 19.'.78.. .......................... crud resulting in the action, as indicated be!ow: ( ....... ...:~..) ( ............ ) ( ............ Application approved: Application denied. Application tabled. 2. Comrnen[~ and remarks: 3: If your application is approved above, A Permit Fee is now due, and should be made payable to the order of the Board of Southo]d Town Trustees. This fee is computed below according to the Schedule of Rates as set forth in the Instruction Sheet (Form I/1). If the Permit Fee is paid in person to the Secretary of the Board, The Permit will be ob?oinable at the some time. if the fee ~s paid by mail, the permit will be mailed in reply. Computation of Permit Fee: 5' x I0' float = 50 sq. ft. 2 posts $1.00 ea = less paid $ 5.00 $ 2.00 $ 7.00 5.00 $ 2.00 Total Fee for this application ............................................................ $ 7°00 Signed Philip G. Horton Chin. Board of Southold Town Trustees. ..... .... BOARD OF TOWN TRUSTEES Town Of Southold Main Road Southold, New York 11971 APPLICATION FOR FIXED and 'or FLOATING DOCKS 1. Applicant's name and address: ............. ..~.~'.l~J.~ ............................................... ...................... 2 Contractor's name and address: ................... .,~..~.~.~.. ...................... ~-..~....~..¥.--~.....~ ................. ......... ......... 3 Briefly explain the purpose, of this application: ......~.O.......~..~;.~.~...~L...~.... ............................ 4 After issuance of a Permit, I expect to: (mark by an )~) / (a) Commence work AT ONCE ............ , ASAP .............UNKNOWN ............. (b) Complete work in -- 1 DAY ............. 1 MO ............. ; 1 YR ............. ; FUTURE ............. Secure the correct Area Map from the Secretory 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 c SCALE DRAWING which will show Ordinary High Water Mark, the shape and size of the dock and any supplemental pilings which ere needed to hold a floating dock or tie-up a boat. Give all dimensions necessary to determine the area of the dock surface which extends offshore from the O. H. W. M. 6. Will any portion of this construction extend offshore into Town Waters beyond an imagJ)~t~A~ line or boundary formed by other s~m~lar structures along the area s shorehne. YES If it does extend beyond this so-called dock line indicate by how far, approximately, .......... ft. Provide the following documents: (a) A Licensed Engineer's Survey of the property involved. (b) A copy of the Contractor's Plans and Specifications. 8. Will this construction require the Filling of any land offshore of the Ordinar)~kJ, igh Water Mark or the Dredging of any material from Town Lands under water.,:) YES or,NO.)If it does, Form Al4 (Application for Dredging/Filling) must be completed and attached a~art of this application. In requesting approval of this application, I submit that: the information presented herein is true and correct to the best of my knowledge and belief; am the person accountable for the performance of the work in accordance with the plans and specifications attached; I have read or am familiar with the provisions 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 Permit, when and if issued to me. Dated: ~;~-