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Home My WebLink AboutAmiaga, Ann James F.King, President - �QF SUUTy Town Hall Annex Bob Ghosio,Jr.,Vice-President- �Q� Ol0 54375 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer � �� Telephone(631) 765-1892 Michael J. Domino Q Fax(631) 765-6641 1�coum,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD JA# Southold Town Board of Trustees TROPICAL STORM SANDY EMERGENCY APPLICATION Valid thru June 1, 2013 Property Owner Name: RN fl M 1 fl(5ft- Permanent Mailing Address: 2332. c R. `�'21 S oo-n+o L l�r Phone Number(s): Property Address: 52�`�2 c , $� 5��r r�-?��-t� E y r 1'7 7) Suffolk County Tax Map Number: 1000 - 1 �3 -03-17. f -Agent (if applicable) Address: Phone Number(s): Board of Trustee Permit Number(s): Will any part of this project require a Building Permit? How much fill will be required? ,^ Project Description: r -� c7 ---- ---- -- w�•¢� �. -(Z7 I County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE HE S THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND_-T STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/i ER OWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MA SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature of Property 63kner SWORN TO BEFORE ME THIS '1 DAY OFTaN L 520/� Notary Public CONNIE D. BUNCH Notary Public,State of Now York No.01 BU5185050 f Qualified in Suffolk County Commission Expires April 14•,2_o1�p ,�gl�y µ�A1 p�,� . iY y",�' I. t 1�,�� p� r` v... 1` a�� 'IwA'J1f r� 7i 1 '; N< �'Ltd r r, .�. - �'� ,Ill i ��,� N �� -2 _ �^ vats i 1 1� 1 'I1 S Y N ► r.q. now - 4 _ /0, Oo \01. +0 FRAME SHED \j .F • �opOP�Q. '�v�Qy• Q� OOD .. q� wkk Oa • a N; a eo O• SOFA � �0�O 10 . •2�S .••. '.. n: r� �•y�o � `!V ry^��O �YOOO EQGE � ill N '�' �`\,- � � ss• OOFc�� c+E�'a�� ++elf++•t` r �� `��. �a �1 oo so e l F9LF OF, 4, J 'F*OO\ / S JC3`0 '59 tiOG 4�°os>FA\ �os� 2 4.0 4.' sF eG "�s 43°33'20,,, W 2 9.45' G 5. s>> S 1201592773 W 7�, 2 5. 1 5' ,;� xl� •nape --' n-xem d E. S°III•fD N ISLAND /r LAND m, P T J •` E aa+ xs.+ $ . _ ImN�'oN i M1 0.6 sol Pam. NORTH FORK 9EACH F`�i (x1NDOWNIUY F�• P�. r � JO(e/ i SEE 9ECTIONb a 102 m r 3 P 83 A? 0 �: �... ...SOUNU /LONG IS✓'ND c F .I-- . CPO 41 P % '� �`�' ~c� " � r r r •Ott S� r rs DR. ecYt.r.ao 5 �yWT R 6 h / N KO erq E�� _�_ "'� r +) �" -- -- o�Y' _�'-- 1°• __ __ u. NOTICE COUNTY OF SUFFOLK © E m w SoNHOLo SECTION NO •'—""' Real Property Tax Service Agency v G ---- -- E3A.a n awn cc.0 m o�m r�r u ryumv