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HomeMy WebLinkAboutCLEAVES POINT PROPERTY OWNERS A/3 - Rev. 6/72 BOARD OF TOWN TRUSTEES Town Of Southold Southold, New York 11971 Main Road APPLICATION FOR A BULKHEAD, DIKE, OR JETTY (Ge Je at,h — -7 7 - J-- 1. Does this project involve the use of WETLANDS as defined in the Southold Town Wetlands Ordinance? YES or NO. If it does, you must file through the Town Clerk's Office. 2. Is the proposed work entirely within the boundaries of your own property as substantiated by your Deed or Survey? YES or NO. If it is, a Permit is NOT required from this Board, but the Town Building Inspector should be contacted for full details. 3. Applicant's name and address: .....................�S ' ".. ...3�.r.� ^ ...... . ..... ...................................................... kgkrl-a n f l� - ��etcte. ? �` ahnet-5..-�/ Sr c�/ Sfo7. lCyl............. ........ .... 4. Contractor's name and address: .....L'.... `ie - -h�ef 4�e� �G7�.. ...... ... ..................................... ............................................ .................................................................................................................................................................. 5. Explain briefly the purpose of this application: v Ae� Co/y/11-o/ e/-OS/Of7 ..:............... .........................,.c..,[......................... . G17` /S GfJC1S�J//!J�f a�f q. ...�i'��5 G1G .. /?eel.?.',Ci//�G�l................. ........ / ............. ..... 4 rresr � ................................................1.5:....Ul.............. Gil4.T..e r.............................................................................................................................................. 6. After issuance of Permit, I expect to: (mark with an X) (a) Commence work — AT ONCE........; ASAP ............: UNKNOWN TIME ............. 4- (b) Complete work in. —;DAYS'...........; 1 MO. ............: 1 YR. ............; 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 O. 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 or boundary formed by existing works of a similar nature along this area's shoreline? YES or NO. If it does, state the approximate distance beyond, ... ft. C ,Qa�f ©P2/V 10. Will this construction require the Filling of any/ land offshore of the Ordinary High Water Mark or the Dredging of any material from Town Lands under water? YES or NO If it does, Form A/4 (Application for Dredging/Filling) must be completed and attached as part of this application. 11. 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. � � L. ............................................................... Accepted by: Dated: �`,J/,ti 5 'G AS R L• !, \ C 1 - G U F'ONU RG U h ' E 4 SHIPYARD LANE i I LETTE I DRI VEI I �'. t MIDLCND A ; 1; ' CEDAR LANE ROcK : Y pO 3 a CZD �N ' ORCHAR r ?8 = 2 ROAD y _ GJAC 4 CfL'u✓t'.S.- PD1' C .1 `ti •1�r � 1��Y'� �;t'1 i l,'�� �J�.�1 �\� '11,i��r? 3) Jc 7'0 G e OM - �`1 40 / >7�/� c)u�`►w !', i/; 7'e lie/r,:,i n)dtlt'!d /JY' �rf:;�f?' T%�. 6✓:?� :crx4' T �f r ✓:a�� l�� x�l 7.'. �'1` .JO:rfr1Ci41 l,l•N. tt!- !� - i , �' " i JU Tr ��t� AM, - ly- z6i C�It�i7�.'/r � ', fr'3� 'i,.;ll:'0'.'►. �i C 7`1Ci� J. Z-3