HomeMy WebLinkAboutTR-750Board Of $outhold Town
SOUTHOLD, NEW YOR'K
PERMIT NO, 75o DATE: ~.~P~.,
ISSUED TO . Ha.ha g.~ Shaw .........
Pursuant fo fha provisions of Chapter 615
~fhe. S~afe.of New York, ~893; and Chapter 404
~'~e of :New York 195~; and fha Soufhold Town Ordnance
+if led "RE~ULATIN~ AND THE PLAGIN~ ~F OBSTR
IN AND ON TOWN WATERS AND PUBLIG LANDS
RE~VAL OF SAND~ GRAVEL OR OTHER MATERIALS F
.'L~NDS UNDER TOWN WATERS;" end in accordance
Resolution of The Board adopted at a meeting held bn
t9, !2 , and m consideration of the sum of $ ,00
.~,~. ~.~ .: ,.....::. ,., ...',,~. ~ ,~.~ ........ ....',~.._~.~ .....
o~ .~n...~y~.~..~..,.~.~g~o.L~ N. Y. and sub eof ~o
T~rm~ ~nd Condd~ons hsfed on the reverse s,de bereft
of Sbuthold Town Trustees aufhoe~zes end permits the following~
Constr~ct a ~ulkhead g0' ft. across applican~
pr6perty on Corey Creek, lot ~2~ p~ivate road~
"KOke Drive, Southold, New York,
ali in accordance with the defa,J d spec,f,cahons as presenfe~
the orig;nafing applca+~on.
IN WITNESS WHEREOF, The said
~y causes, its Corpora+~ ~al ~o ~ affixed, ~nd these
e subscribed by a majority of the said Board es
~ '~" '- ""'"'""--"~ ~ ~tees --
YoUr aPPlication, dated' e~t, 11, 1972 has been rev t meeting of the Truste~s held on sop
2. ,Comments and remarks:
31. If your application is a~)proved above
and skould be made payable to the order of t
?own Trustees. This fee is computed b~tow accordin :hedule
of Rates as set forth in th~ Instruction Sheet
the
If the fermlt Fee is pald in person to the Secre
Board, The Permit will be obtainable at the same time. ~ fee
pBid: by mail, the permit will be mailed in reply.
Computation of Permit Fee:
Bulkhead On applica~,s own
Total Fee for this~application:~
Signed
Chm, Trustees.
B~ARD OF SOUTHOLD TO~-N TRUSTE~ un A/3=
rev/6/72
LIBATION ,'O.~ A BULK}lEAD, DIKEr OR JEST=,
!. Does this project involve the use of WETlaNDS as defLned in the
Southold To~m ~,etlands Ordinance? ~rNO. If it does, you
must file through the To~ Clerk's Office .
2. Is the proposed work entirely with~ the bo~darieS of your o~
proper~y as substantiated by your Deed or Survey? YES or NO.
If it zs, a Fe~it is NOT required from this Board, but the
Towm Building Inspector should be contacted for full details.
5, Expla~ briefly nhe purpose of this application:
~,! ~. After issuance of Permit~ I expect to: (mark with an X)
f (a) Commence work ..... AT ONCE ...; ~
ASAP
UN}~NOW~
TIME
(b) Complete work in--1DAY ; 1MO. ; 1YR,. ; FUTURE _.
~' 7. Secure the correct Area Map from the Secretary of this Board, and
t by using an X WITHIN A CIRCLE as a mark, indicate as closely as
possible the location of this project. On the reverse side,
provide a SCALE DRAWING which will show Ordinary High Water Mark
as well as the size and shape of the structure or work to be done.
Also include all dimensions for portzons which extend offshore
from the O.H.W.M.
8. Provide the following documents:
(a) A Licensed Engineer's Survey of the property involved.
(b) A copy of the Contractors Plans'& Specifications.
9. Does this project extend into Town Waters beyond an imaginary
line or boundary formed by existing works of a similar nature
along this area's shoreline? ~ or NO. If it does, state the
approximate distance beyond, ft.
10. Will 'this construction require the Filling of any land offshore
of the Ordinary High Water Mark or the Dredging of any material
from Tovzn Land? under water? ~. or NO. If it does, Form A/4
(Application ~or Dredging/Filling) must be completed and attached
as part of this application.
11. In reqaes~ing approval of this apptication~ I submit that: the
information presented herein is true and correct to the best of
my knowledge and belief; I am the person aeconntable for the
performance of the work in accordance with the plans and spec-
{fications attached; I have read or am familiar with the pro-
visions of any Southold To~m Ordinance pertinent to the work
involved; and fur~her,I intend to adhere to and abide by the
Terms and Conditions of the Permit~when and if issued to me.
X X;4XYJ<XXXXXXX XXXXXXX,KXXXXX XXXXXXXXXX~X!KXX~Y2~LK.'cKXxxx XXXXXX~K~X~.XXXKXY~
Accepted b~. ~.~'",~cJ_/z/c/ D?~/,~:;~/[ /'7~-----~