HomeMy WebLinkAboutMiller Merritt ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
· ' MAR~GE OFFICER · -
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOR/VlATION OFFICER
Town Hail, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
....... Fax 1631) 76~-6145.,
Telephone (631) 765-1800
southoldtown.northfork.net
OFFICE OF TItE 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.~'~°7-'0' 7
Permit No.
Applicant Name tqq~f~>~i'~'l' O.) I"YhlLU~
Applicant Mailing Ad.ess I OK ~ O A ~ ~ ~
~~, N~ ~9~/
Septic T~ ~' or C~sspool
BhefDescdption of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
OwnerofProperty: h"lO_A"CIl-~ CO
OwnerMailingAddress: [0 ~ ~ O ~ t~
Owner Property Address: .Tq g Or~/~
.5ou T/4~ Cd, N
Name and phone number of contact person me_CD
Tax Map No: Section ~O Block I Lot ~_
Cross Street f~G,qt'~o '~ .
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
S~gnature of Applicant
~)ate
Received by:
254.60'
$. 77,:~2.00' W.
LOT ~
SUR VE Y OF
L 0 TS 39 ru 42 inclusive
BLOCK C ,,
"RE)DON SHORES
FILED JUL Y 2,193[ FILE NO. 631
A T SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N Y.
1000- 80- 01- 33
Scale: 1" = 40'
Dec. 27, 2002
MA Y I~ 2003 ( prop. addition
The Iocofions o/ wells o.n.d cesspools
shown l~e~eoo ore /rom field observelions
cod or from defo obfoioed from olbors.
I ~ ~ w~ I~ STAND~IRDS FOR APPROVAL
AND ~~
~ ~
ELEVA TION~ ARE REFERENCED TO THE FIVE EASTERN
TOIFN$ TOPO6RAPI~C MAPS
ALL ~Y~S U~LI~ A C~Y
~UC. NO. 49618
~,t-co~c s~ ~.c.
[631) 765 - 5020 F,4X (63/? 765 - /797
P. O. B~ ~9
1~30 TRA VELK~ STREET
S~TH~ D. N. Y. ,V9 7/