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Board Of Southold Town Trustees
• �� �) !�� %mac
{! SOUTHOLD, NEW YORK
Mooring No. N/A
2210O DATE:N
i,
Its �• �` .
[ a tea 1«�,IEI1 TO T. Mo6r- Jankowski, M.D. ►,;
s, r �ai .................................................................... :..............................................................
:.. . ......
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Pursuant to the provisions of Chapter 6'15 of the Laws of
the State of New York, 1893; and Chapter 404 of the Laws of the
State of New York 1952; and the Southold Town Ordinance en- ,� a
F: titled REGULATING AND THE PLACING OF OBSTRUCTIONS .: ;1
IN AND ON TOWN WATERS AND PUBLIC LANDS and the r
{� REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM ..:•,�
LANDS UNDER TOWN.. WATERS; and in accordance with the
Resolution of The Board adopted at a meeting held on 49.!.... ........ ;, r
19. 86 :., end in consideration of the sum of $...5................:....... paid by
.T.....Moor/Jankowski,...M.D.r..............:....00.....................................
of ........Southold................
........... ....................... N. Y. and subject to the ,
' ! Terms and Conditions listed on the reverse side hereof, ` '?
.t . .Of Southold Town Trustee_ s authorizes and permits the following: - 4�
., Approval to secure a permit for a bulkhead under the Pik
F
,•. ' �! Grandfa,ther. Clause 'all in accordance with the application
'' submitted. k
l ''a all in accordance with the detailed specifications as presented in
- . ,. p ,
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to
r Ia be subscribed by a majority of the said Board as of this date.
.... ..... .. ...........................................
Ln
( ..................... ! +�U.
......................-... .........
....................................
Trustees
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600
Please tear off and return to the Trustee Office.
Board Of Southold - Town Trustees
SOUTHOLD, NEW YORK
Mooring Permit - No. Date:
Mooring No.
I� certify that• the- work as
authorized in this permit has been completed and is now ready
for your inspection. Also, the number required on this project
is clearly visible. I further understand this permit is not valid
until "this tear off sheet is returned to the Trustee Office.
TERMS and CONDITIONS
4
The Permittee T. Moore/Jankowski, M.D.
residing at Carole Road, Southold N. y., as
j/AiL -AA ll1C LVLL1l.iCl{aYVli JVl the aJJ.LaaaG('. Va'—`z L fAa 16 UV aY UY LO%,&U%1 -U1 YIGJ{ilUr. •V L LVi- " l `
lowing: 1. That the Trustee Permit.most be prominently displayed on the premises Et
effected thereby during.the period of work under the permit.
1. That the said Board of Trustees and the Town of Southold are released from any and .
all damages, or claims for damages, of suits arising directly or indirectly as a result of any oper-
ation performed pursuant to this permit, and the said Permittee will, at his or her own expense,
defend any and all such suits initiated by third parties, and the said Permittee assumes full liability
with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold
" 2. That this Permit is valid for..a period of 12 mos. which is considered to be the
estimated time required to complete the work.involved, but should circumstances warrant, request
for an extension may be made to the Board at a Ilter date.
3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes
to maintain the structure or project involved, to provide evidence to anyone concerned that auth-
orization was originally obtained. <
4. That .the work involved will be subject to the inspection and approval of the Board or
-its agents, and non-compliance with the provisions of the originating application, may be cause for
revocation of this Permit by resolution of the said Board. -
5. That there will be no unreasonable interference with navigation as a result of the work
herein authorized.
G. That there shall be no interference with the right of the public to pass and repass along
the beach between high and low water marks. .
7. That if future operations of the Town of Southold require the removal and/or alterations
in the. location of the work herein authorized, or if, in the opinion of the Board of Trustees, the
work shall cause unreasonable obstruction to free navigation, the said Permittee will be required,
upon due notice, to remove or alter this work or project herein stated without expenses to the Town
of Southold.
8. That the said Board will be notified by the Permittee of the completion of the work auth-
orized.
9. That the Permittee will obtain all other permits and consents that may be required-sup-
plemental to this ermit which may be subject to revoke upon failure.to obtain same.
-,;(See
_tear ofr sheet.)
0
Name- of 'Creek: �Q
^ion C�gC'
\ T n ..•
1 M t� ,
TELEPHONE
(516) 765-1892
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
GRANDFATHER APPLICATION
c `o
1. Name of Applicant:
2. Address of Applicant . (0 0Q QWA �Q
rS Irpee1 doAkly. �
3. Telephone Number:
4. Year of Construction: G `- ff
5. Sketch of the work including sizes: CZ �J 6U1U QL1
k6l� V4Q_\A 4�je] 0 \AA
6. Mark off on the map attached, where your property is located
using an
r
Signature:
Please note t at there ' s a $5. 00 filing fee, which is a one time
fee, for thi applicatio .
Mooring Applications- $5. 00 Application Fee and a $5.00 annual renewal
fee each year.
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