HomeMy WebLinkAboutTR-248 TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
PEt%MIT NO.
Pursuant to the provisions of Chapter 615 of the Laws of 1893 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 Soathold adopted at a meeting
of said Board on ......~..~t;:.~...~.~.~....~..g.~.;~ ............. , and in consideration of the sum of
$....~.G..,.O..Q., lawful money of the United States, paid by....;~;C.~:~g...~.,,..~,~.~.~..~.,....~..~..,..
residing at ...~..~.~...~.~g..~.....~...o.~.~.....~.~.~.~...O.~.~.f...~,.!.~ ................................ , New York,
the said Board of Tru~ees of the Town of Southold, Suffolk Count, New York, hereby
authorizes and permits said .......... [~.~.,...~,...~.~..~..~ ........... to
~. D~ ~%h, ~Jo~g n~ighbors.
The said ..... ,T~.~.~..~,,...~.~te£.~..~;L;~ .......... as part of the consideration
for the ~ssuance 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 carried on under and pursuant to this
permit, and will at his own expense, defend any and all suits which rna~/be brought by third
parties as a result of any operation carried or pursuant to or in accordance with the terms of
this permit, and <~ssume full Jiability with respect thereto to the complete exclusion of
said Board of Trustees and the Town of Southold.
~0~ NO. ~
TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLD, N. ¥.
........_ ...............................
Examined
Approved ...... _...~,r~....................................." .~~ .............. Perm t No .......................................
Disapproved a/~"/ ...................................... ~..~ .......... ~ ........................................................................................
................................ ..~'~--,rr~c.....Z.~..~.~F~airman, Board of Trustees
/
× APPLICATION FOR PERMIT
INSTRUCTIONS
A. This application to be completely filled in by typewriter or in ink and submitted to the Town Trustees in duplicate.
B. Plot plan showing ocation of lot and buildings on premises, relation to adjoining premises, public streets, parks, etc.,
and giving detailed description of proposed layout of proje~ct must be drawn on, diagram which is port of this appli-
cation.
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 will issue o permit to applicant. Such permit shall be kept on the
premises and available for inspection at oCli times.
E. Applicbnt 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 p.ermit pursuant to the la~vs, ordinances and regulations governing construction of: docks, pier. s, bulkheads,
jettys and !dredging in; under, and over the waters of Town af Southold. The applicant agrees to comply with oil appli-
cable laws, ordinances, regulations and conditions specified by said trustees, and to hold the Zowr~ of Southold, and
Town offidials free from liability and damages of any kind.
Name of OWner of premises ........ ~r~ar~..~%..~,D~..~'.....~.~i~..~l,~....~,...~f~.~..~ ................................................
Street Address of Property .................... .]~i~..~.~.....~i]~a:L~l.~.~.~Z, .................................................................
Home Address If Other Than Location ......... ~p~..G~t~..g~.,e....~] ~,~..D..~. ............................................................
Creek, Bay or Harbor Fronting Property ..... .~..6.9.~.....~...~..~.. ............................................................................
Permit Requested To: ........ a~.~..~z~l...~z'~f~..b.C~t~k ........................................................................................................
Size of Proposed Work: Length ...... ~.~.. .................. Width ...... .~..0. .................. Heighth Above High Water......~..,~...'. ............
Depth Below Low Water ...~..~.~o ............. Average Rise In Tide ..... ~...~¢~..... Yards To Be Excavate~d ..........................
Width of Canal, Creek or Bay Fronting Property .......... .~t..-~, ................. Depth at Low Tide .~.~.~.,~..~.~.*. .......
Is This ForiPrivate or Business Jse? ....... .D['~,~.~. ................................ Area Zoning ..... ~.~..~.~ .............................
Complete plot plan to be drawn on reverse side of this application.
STATE OF ,NEW YORK)
.... ~..=.=.~..~ ......... 4....=.~.~.~ ......... ', b~ing du ~y sworn, deposes ~nd iays that he ~s fhe applieenf for fh~ above described
permit, and t~at all statements contained herein are true to the best of his knowledge and belief; that the work wilt be don~
in the manner set forth in the applieetion and as approved by the Board of Trustees of fh~ Town of Southold, and the
applicant qgrees to hold the Town of Southald a~d said trustees ha~m[ess and fr~e frO~ any a~d all dama~ and claim~
arising under or by vi~ue of said permit.
( / (applicant)
~ ~DEN
No. 52-0367~0