HomeMy WebLinkAboutBraverman Stefurak OFFIC~ OF T~ TOWN CL~IK
TOWN OF ~OUTHOLD
ELIZABh-'I~-I ~ NEVII 1/:: TOWIq CLERK
P.O. BOX i~79
$ODTHOLD, NEW yORK 11971
Telephone
(63-t) 765-1800
Alteration
$10.00 - Residential
$25.00 - Non-Residential
-. TOWN OF SOUTHOL, D
~ SOUTHOLD WASTEWATER DIsPoSAL DISTRICT
r
-, o for
~/~ ~.~_~. CONSTRUCT ION r ALTERAT ION PERM IT
~'/~ SEPTIC TANK or cEssPOOL
Permit No,
DATE July
2003
APPLICANT NAME:
APPLICANT ADDRESS:
SEPTIC CESSPOOL
Michael Braverman and Mark Ste£urak
425 West 23rd Street.
New Yqrk., NY 10011
X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Construct new relocated cesspools
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ,ALTERATION:
OWNER OF PROPERTY: As applicant
OWNER MAILING ADDRESS: As applicaz~t
OWNER PROPERTY ADDRESS: 2755 Cedar Beach Road
Southold NY 11971
TELEPHONE NUMBER OF CONTACT PERSON: 734-5800 (Ja~es ?itzgerald)
TAX MAP NO.: Section 91 Block 1 Lot 1
CROSS STREET: ?aradise Point Road
BUILDING PERMIT NUMBER CROSS REFERENCE: _
RECEIVED By.~~~ '/ Sig-~ature//'''~'en~
Clerk's'
Office
DATE: ~
The Ioca~i°ns of wells and cecspool~
shown h~reon ere from field obsemCe#ens
end or frOm ~1~Io obtained from o1~.
SUFFOL~ COUNTY, NEllr YORK
SYSTEMS F~
/
i
tV 76..?,3.00. W
/
~TER~TIBN DR 4DDITIDN TD THIS SURVE~ IS A VI~ATIDN 7209 OF THE NE~ Y~RK STATE EDUCATION LA~,
PER SECTION 7~09-~UBDIVI%~N ~ ALL CERTIF~CATI~
A~ VAL[~ F~ THIS ~P AND CDPIES THEREOF ~L Y
~ C~PIES BEAR THE I~RESSED SEAL DF THE SUR~Y~
~I~T~E APPEAR~ HEREON,
7'6..5 - 5OE'O F4X:<63~) 765-1797
~5
N. Y, ii971