HomeMy WebLinkAboutTR-388 TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
PERle, IT NO....~...(~.4~/ ......
Pursuant to the provisions of Chapter 615 of the Laws of 1893 of the State
of New ¥o~k; Chapter 404 of the Laws of 1952 of the State of New York; the pro-
v~s~ns of an .ordinance en~tled "Soutbold Town O~din~ce Regu~tmg the Placing
of Obs~ctions in and on Town Waters and ~blic Lands, and the Remov~ 0f Sand,
Gravel or ~o~er ~Iateriais from L~ds unde~ Town Watts", ~d in acc~rd~ce ~ith
the resolution of the ~d ,of Trustees of ~e Town of Sou~old adopted at a m~t-
~ng of Said Board on .~...~. ~. ~.., and ~ consideration o~ the sum
iav u mo ey States,, ..
residing at .... ~. ~. ~ ~!~,-~. ...... , New Z~ the
Board of T~astees of the Town of Soath old, Suffolk Coanty, New York, he.by
au~korized .and pe~2s said ....... ~. ~.: :. ~ :~e. ...........
The said ..... ~.~. ~. ~. ~$~. ........... as pa~ of the consideration
for the issuance of this permit does hereby release the said Eoard of T~stees and
the ~own of Sou~old from any and all d~es clams for d~ages or suits thai
may ar]se ,or occur directly or indirectly as a result of ~y operation calwied on un-
der ~d pursuant ~o this pe~it, and will at his own expense, defend ~y and all
suits which may be brought by third p~es, as a result of any operation ca~ied
on pursuant to ,or in accord~ce with the lerms of this pe~it, and ~sume f~
liability with respe~ ~ereto to the complete exclusion of said Board of T~stees
and the ~o~ of South,old.
T~S PE~T is subje~ to the following terms and conditions:
1. That there shall be no unreasonable int~Yerence with navigation ~ a result of
the work herein authorized.
2. That there sh~l be no ~lerference with the right of the public to pass and
p~s ~ong that p~ion of the beach between low and high water mark.
3. Thai the work ~all be subject to the supe~ision ~d approval of the said
Board of T~stees or tis agents.
4. ~at ff future operations of the Tow,n of Southold require the removal ~d/or
alteration in the location of the work herein authorized, or if, in the opinion
of the Board of T~stees of ~he Town of Southold, such work .shall ~use
reasonable cbs/faction to f~ee na~gation, the said . ~..~,,..~ .~
will be requ~ed upon due notice from ~e said Bo~d of T~stees, to r~ove
or alter the location of the ~ork hereby author~ed withou~ expense to the
Town of Southold, so ~ ~o render navigation reasonably free and unobs~ct-
ed.
The authority conferred by this permit may be terminated by theBoardaf Trustees
J:or c failure on the part of the said .......... ~.~..~.~....~.,.....~.~tt~ ...................................... 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 wl~en ~J~e Board of
Trustees she. FI mail to the said ................ .J~..~.,....,~..,....~.~...~.~...e. ............................... at the
address given in his application, a certified copy of a resolution of the Beard of Trustees
directing such termination.
IN WITNESS WHEREOF, the said Board of Trustees of the Town ef LSeuthold has
caused its corporate sea,l to be hereunto affixed and these presents to ;be ;sdbSCribed by
a majority of the said Board of Trustees, the day anc
seal (L S.)
STATE OF NEW YORK )
SS:
COUNTY OF SUFFOLK )
all ~rsonally known
to me, who, being by me duly sworn, ~veraHy said that they each resided in the Town
of Southold, County of Suffolk, State of New York, and were members of¢~e Beard of
Trustees of said~ Town of Southold and constituted a majori~ of the some; that they
knew the co.orate seal of said ~o~ of Southo~d; that the seal affixedto 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 si~ned his.name thereto as
a Trustee and by like order.
FOEH NO. 1
TOWN OF SOUTHOLD
BO^RD OF TOWN TRUSTEES
TOWN CLERK'S OFFICE,,,~ .4~ ¢--.~' ~'
SOUTHOLD, N. Y.
Examined ............................. 19 ...... Application No ..................
Approved ..~..~..../.~..~.~. ................. Permit No .............................
..................... chairman. Board of Trustees
APPLICATION FOR PERMIT
INSTRUCTIONS -~
A. This application to be completely filled in by typewriter or in ink and submitted ro the Town Trustees in dup-
licate.
B. Plot plan showing location of lot and buildings on premises, relation to adjoining premises, public streets,
parks, etc.. and giving detailed description of proposed layout of project must be drawn on diagram which is part
of this application.
C. The work covered by this application may not be commenced before the issuance of a permit.-
D. Upon approval :of this application, Town Trustees w/II. issue a permit to applicant. Such permit shall be kept
on the premises and available for inspection ar all times.
E. Applicant shall notify the Board of Trustees upon completion of the work covered by permit.
APPLICATION IS HEREBY MADE 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 waters of Town of Sonthold. The applicant agrees
to comply with all applicable laws, oi'dinances, 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.., d.~. ~.. ~.~..~ ...........................................................
Street Address of Property ......... ~ .ff.../)~..' .~. .......... .~..~'.~.~.r....?.~ ~ ...............
ZT: ,_ .................................
Depth Below Low Wgter... 7~* 'l~"J/'~' '~'Average.--t__ ~-~Rise In Tide...a.~./~....~....Yards to Be Excavated.j~'~..~
V¢idth of Ca~al, Creek or Bay Fronting Property,~.~./~.-./.../~' .......... Depth at Low Tide .~.~...~. .............
Is This For Private or Business Use? .... .~.~ .................. Area Zoning .~.ff.~ .........
Complete plot plan to be drawn on reverse side of this application.
8TATF, OF NEW YORK )
)s.s.
COUNTY OF )
..... ~.' ......................... being duly sworn deposes and says that he is the applicant for the above dc~
scribed permit, and that all statements contained herein are true to the best of his knowledge and belief: that the
work will be done in the 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 said trustees harmless and free from any
and ail damages and claims arising under or by virtue of said permit.
f r h ~ ~,~ (applicant)
Sworn to be o e me t is...~'~',..-- ..... day of .... ~9...~./...
Term Exp. Jres Mam,~ 30.