HomeMy WebLinkAboutReese Harold ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
- · · MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 MEn Road
P.O. Box 1179
Southold, New York 11971
Fax (631)765-6145
Telephone (631) 765-1800" '
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK '
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10~/ or Non-Residential ~ $25 __
Application No.[~)-.~
Permit No.
Applicant Name C_.~/~/~t~_ ~,~
ApplicantMailin~res~/~--)~ ~' ~t~~/' ~.~' ~..~t~
Septic Tank ~or Cesspool
Brief Description of Proposed Construction or ~.Ileration
L°cati°n ° f Pr°p°sed C°nstrucJjW~ l~rati,°n).,ff _ /~,~,, kX
Owner of Property: ~; ~/~ ~
Owner Mailing Address: ~~ ,
Owner mrope~ Address: /¢~ ~ *~,~
N~e ~d phone number of contact person
Tax Map No: Section ~~ Block ~ Lot
Cross Street
NOTE: LOCATION MAP MUST BE SUBMJTTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WIT~ESL~H DEPARTMENT APPROVAl/
Signa~ure'o~ A~l~licant I~ate-
JOB No. 02-39 R~.~ .~eo~
TEST HOLE 8/30/02
[ GEOSClENCE ]
BROWN CLAYEY SANI
WTFH ~ GRAVEL
SURFACE ELEV 800
OL 11' BROWN LOAM
to
~)pA~ LOT 64
[ pROPos'~4~ RES WELL
~u PUBLIC WATER
TAX I.D.No. 1000-79~)7~3
TAX LOT 55
vACN'I'T
N 21°33'20"E 104.73'
'X
TEST HOLE X
FF 99.5
GAR ~.0
TAX LOT 62
OCC RES WELL
36°45'30"t4/ 52.48, ~ ~ T~ SeZ.8~,
Ms ~- ~ ~ ~ S32"~,~
[ 5o, 1
WELL IN ~ OCC RES WELL
ELEVATIONS IN ASSUMED DATUM
FLOOD ZONE X
FIRM MAP No. 36103C0167 G
ALL DISTANCES TO WELLS AND CESSPOOLS
ARE BY LOCATIONS FROM HOMEOWNERS,
FIELD OBSERVATIONS, AND EXISTING
SURVEYS. SINCE MOST ARE NOT VISIBLE
THESE DIMENSIONS ARE NOT CERTIFIED.
CERTIFIED ONLY TO:
SCHEMBRI HOMES
By DESTIN G. GRAF N,Y.S. LIC NO. 50067
SURVEY OF:
DESCRIBED PROPERTY
SITUATED AT BAYVIEW, TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
SURVEY DATE: 08/22/02 SCALE: 1"=30'
DESTIN G GRA~i;; ~'~
LAND SURVEYO~'~
PO 80X 7~4
Rocky Poiflt, New York, 11'~,
631~21.-3442