HomeMy WebLinkAboutGreenbriar Homes 'town OF SOIJ'I'HOLD
A. ~ TOWI~ ~
P.O. BOX 11 ?9
,~)LrI~OLD, NEW YORK 119'/1
TelePhone
(63'2) 765-1800
Application No,_~c~ ./
Construction .
Alteration
$10,00 - Residential
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
APPLICANT NAME: d,~~ ~ ~'-~.
APPLICANT ADDRESS: .~"~
SEPTIC ~CESSPOOL ~ '
D~SGRIPTION OF PROPOSED CONSTRUCTION OR A~TERATION
RECEIVED BY:
DATE:
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:'
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: 5action /~ .Block ff ~t ~.~
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Appli~nt
SURVEY OF LOT ti: 12
5BPTIC, ~ETAIL
"MAP OF 60UNTR"¢ CLUB ESTATES"
PILED OGT. I'"/, Iq-l'8 AS PILE # &'"f~6
51TUATE: C, UTC, HO~UE
TOHN OP ff:OUTHOLD
54)PPOLF-. OOUNTY, NY'
A~ENPE~
Af~NDEI2 04-21-00
5UPPOLK C. OUNTY TAX ~
tOOO - IO~ -D -
N
w.+
S
$"1655'
TEST HOLE
4qq-o0
boL ~ \2
NOTtE~:
· MONUMENT FOUND
5R.APHIC SCALE I% 40'
dOHN C, EHLERS LAND SURVEYOR
6 EAST NAZN STREET
R~VERHEAB, N.Y, ~90~
359-82B8 Fax 3Eg-SEa7
N Y S LIC NO ,50202
REFERENCE # 9B-0294