HomeMy WebLinkAboutTR-81-3-5 GFBoard Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. '~ j-'.~ --.5" DATE: .. 3: J~ -c/3)...
SSUED TO .......
Pursuant fo the provisions of Ghspfer 615 of the L~ws of
the Sfaf~ of New York, 1893; ~nd Chapter 404 of the Laws of fha
State 0f New York 1952; and the Soufhold Town Ordinance eh-
flfled "RE~ULAT~N~ AND THE PLACIN~ OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS ~nd the
RE~OVAL OF SAND, ~RAVEL OR OTHER ~ATERIALS FRO~
~NDS UNDER TOW~ WATERS:" and in accordance w~fh the
Resolution of The Board adopted at a meeting held on ~ ~..~H~.
19 , ~nd in ~onslderaflon of fha sum of ~ ~ pa~d by
of N.Y. and subject to fha
Terms and Con~ions I~sfed on the reverse s~de hereof,
of Soufhold Town Trustees au~horlzes and permlfs the following:
all in accordance with the detailed specifications as presented in
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes ifs Corporate Seal to be affixed, and these presents fo
be subscribed by a mejorlfy of fha said Board as of this daf,e.
~.,.. ~ .... ~ ....
..................................... .............................
TRUSTEES SCOTT L. HARRIS
John M. Bredemeyer, III. President Supervisor
Henry P. ,Smith. Vice President Town Hall, 53095 Main Road
Albert J. Krupski. Jr. P.O. Box 1179
John L. Bednoski. Jr. Southold. New York 11971
John B. Tuthill BO ARD OF TOWN TRUSTEES Fax (516) 765-1823
Telephone (516) 765-1892 TOWN OF SOUTHOLD Telephone (516) 765-1800
GRANDFATHER APPLICATION
1. Name of Applicant: ~..Cr-
2. Mailing address: ~ ~
3. Address of Property: ~..~:0~ ~-
4. Tax Map N~ber: 1000- ~I' ~' ~ Approx.yr.of construct:
5. Prior owner if known: ~ ~ ~
6. Diagr~ of existing structures, including all dimensions, must be
included with this application:
7. Indicate on attached map: Location, ie:f-reference point, telephone
pole number, adjacen~ proper~/owne~s,/~c. ·
Signature of applicant:/~//?/~~-~ -- Date:
· Please note, there is a one time fee of $50.00 for filing this
application