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Board Of Southold Town Trustees
SOUTHOLD NEW YORK k1: `
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` PERMIT NO DATE t.
p 1 976
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� .....EDWARD....Vii......NIXON......................................................
ISSUED TO .......................
IN
Pursuant to the provisions of Chapter 615 of the Laws ofX:.: '
�! 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-titled "REGULATING AND THE PLACING OF OBSTRUCTIONS '~
IN AND ON TOWN WATERS AND PUBLIC LANDS and the `' s
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM s� `-j �-
," €, LANDS UNDER TOWN WATERS; and in accordance with. the
Resolution of The Board adopted at a meeting held on .5ept......13,
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19....7..6.., and in consideration of the sum of $ .......... paid by ilk:
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South...I;ot....Roax
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I i ::. ::'=__ I o f Smithtown R.-...N.Y. .-.........117 87..........
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............... N. Y. and subject t he !
Terms and Conditions listed on the reverse side hereof, I;
T ,s II I
of Southold Town 'Trustees authorizes and 'permits the following: 't3
� ,, "!! Permission to bulkhead on applicants property at
� j Mud Creek, off Bay Avenue, Cutchogu e, N.Y.
f _ All lands seaward of bulkhead shall remain Town.71 ,N <
a in accordance with the detailed specifications as presented in
per
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here- i k
!
r � al to be affixed, and these presents to
by causes its Corporate Se
be subscribed by a majority of the said Board as of this date.
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Trustees
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TERMS and CONDITIONS
The Permittee
t , o .
residing at N. Y., as
part of the consideration for the issuance of'the Permit does understand and prescribe to the fol-
lowing:
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
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 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 later 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 permit which may be subject to revoke upon failure to obtain same.
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A/S - Rev. 6/72
BOARD OF TOWN TRUSTEES
Town Of Southold
Southold, New York 11971
Main Road
APPLICATION FOR A BULKHEAD, DIKE, OR JETTY
1. Does this project ie the use of WETLANDS as defined in the Southold Town Wetlands
Ordinance? YES or O If it does, you must file through the Town Clerk's Office.
2. Is the proposed work entir. within the boundaries of your own property as substantiated
by your Deed or Survey? 'E or NO. If it is, a Permit is NOT required from this Board,
but the Town Building Inspector should be contacted for full details.
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3. Applicant's name and address: Az �/f�IV................ ........................................................
............... Y
.........................
4. Contractor's name and address: � GrC
..................................................................................................................................................................
--' ✓ A-1 T OF
5. Explain briefly the purpose of this application:/.. ..........................t -�.ss�............
....
Z. ................... o.t�� foes �F�i .ter
................................................................................................................................................................
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6. After issuance of Permit, I expect to: (mark with an X)
(a) Commence work — AT ONCE............: ASAP .x.......; UNKNOWN TIME .............
(b) Complete work in 1 DAY 1 MO. ............ 1 YR. .X......; FUTURE .............
7. Secure the correct Area Map from the Secretary of this Board, and 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
portions which extend offshore from the 0. H. W. M.
8. Provide the following documents:
(a) A Licensed Engineer's Survey of the property involved.
(b) A copy of the Contractor's Plan. and Specifications.
9. Does this project extend into Town Waters beyond an imaginary line o oundary formed
by existing works of a similar nature along this area's shoreline? YES orVO it does, state
the approximate distance beyond, ............ ft.
10. Will this construction require the Filling of any land offshore of the 0 dina gh Water
Mark or the Dredging of any material from Town Lands under water? YES o NO. If it does,
Form A/4 (Application for Dredging/Filling) must be completed and attached as part of this
application.
1 1. In requesting approval of this application, I submit that: the information -presented herein
is true and correct to the best of my knowledge and belief; I am the person accountable for
the performance of the work in accordance with the plans and specifications attached; I have
read or am familiar with the provisions of any Southold Town Ordinance pertinent to the work
involved; and further, I intend to adhere to and abide by the Terms and Conditions of the
Permit, when and if issued to me.
,Accepted by: -eg O g-/,Q-76 Dated: �-Z9- ,
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3uLK C,UtARANTE ED TO THE INTER COUNTY T1ILE GUARANTY
AND MORTGAGE COMPANY
AS SU�2vEY�C DEG 15, 1369
VAN 7 UYLi SON
;GT N45 SH4w�1 WE I E R TO MAP OF NA55AU FAR "M5
NOTE- _ _ _ ---
ON FILE INTi4E 5Uff 0LK COUNTY CL LE AS LICENSED 'LAND 5URVE•�R5
I`�A P NO l 1 �9
p M ONUMENT- s
(Q _IRON PIPE
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