55 Main Street, PO Box 660, Sag Harbor, NY 11963 (631)725-0222
APPLICATION FOR CURB CUT
Pursuant to §300-11.3
NAME OF APPLICANT:__________________________________________________________________
ADDRESS:_____________________________________________________________________________
_______________________________________________________________________________________
CONTACT NUMBER:____________________________________________________________________
TAX MAP NUMBER OF PROPERTY:___________-___________-___________-____________
PHYSICAL LOCATION OF CURB CUT:_____________________________________________________
DATE OF CURB CUT:_______________________LENGTH OF CURB CUT:_______________________
DATE:___________________________SIGNATURE:___________________________________________
CONTACT DEE YARDLEY, SUPERINTENDENT OF PUBLIC WORKS AT
(631) 725-0107 PRIOR TO CUT
EACH APPLICATION SHALL BE ACCOMPANIED BY:
o $100 PERMIT FEE
o A DIAGRAM OF CUT AND LOCATION
o A CASH BOND OR CERTIFIED CHECK IN THE SUM OF $ 500.00 WHICH
SHALL BE REFUNDED UPON COMPLETION AND APPROVAL OF WORK
o PUBLIC LIABILITY INSURANCE NAMING THE VILLAGE OF SAG HARBOR AS AN
ADDITIONAL INSURED IN THE MINIMUM SUM OF ONE MILLION DOLLARS
($1,000,000)
APPROVED____________DENIED_______________ PERMIT #_________________________________
_________________________________________ CHECK________________RECEIPT_______________
SIGNATURE
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