HomeMy WebLinkAboutLong Island Homebuilders ELIZABETH A. NEVILLE
TOW'y~I CLERK
REGISTRAR OF VITAL STATISTICS
·. · MARRIAGE OFFICER .......
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fa~.(631) .7~5-6145
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 ~o~ Non-Residential ~ $25 __
Application No. ~ [ ~:~
Permit No.
ApplicantMailingAddress %0 t~ted&--,~/~'¢ /~,~ ~/]~f-./~'-e,~.,~c.-o---- -.~5'- w/'~-5--c/
Septic Tank /~or Cesspool
Brief Description of Proposed Conslmction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: /t>~ :;Fqd~, .,,~
Owner MailingAddress: "qo ~-o[[,~.e.~-
Owner Property Address: ~/~ ~' ~-- g ~ 7~Pc~ pA
Name and phone number of contact person /~,,~,~, ~ g',,-:~r~,<7'
Tax Map No: Section ~ ') Block ~ Lot
Cross Street ~_ ~ /-r-e t~- ~... ~,-e
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant
Received by:
Date
S.C.T.M. NO. DISTRICT: lO00 SECTION: JJ ~LOCK: 5 ~OT(S}:6 J A
DWELL (2J.O
PUBLIC
WATER ~9.1'
LOT 36 28.<'
LOAMY ~ND 2.5 ~ ~OT
-
,
vACANT
~ND ~/~ T~sKER
AND OR DATA OBTAINED FROM
AREA: 12.771.8 S.F. OR 0.29 ACRES ELEVA~ DATUm:
UNAU~ORIZED AL~RAD~ OR ADDISON TO ~IS SURLY IS A ~AD~ OF SEC~ 720~ OF ~E NEW YORK STA~ EDUCAD~ LA~ COPIES OF ~IS SURLY
MAP NOT BEARING ~E LAND SUR~YOR'S ~BOSSED SEAL ~ALL NOT BE C~SIDERED TO BE A VALID ~UE C~ GUARAN~ES INDICA~D HEREON SHALL RUN
ONLY ~0 ~E PERSON FOR ~ ~E SURLY iS PREPARED AND ~ HIS aEHALF TO ~E ~E COMPAN~ GO~RNMENTAL AGENCY AND LENDING ~NSn~UnON
LISTED HERE~, AND TO ~g AS~GNEES OF ~E LENDING INS~nON, GUARANTYS ARE NOT ~ANSFERABL~
~E ~F~TS OR DIMENSIONS SHO~ HERE~ FR~ ~E PROPERTY LINES TO TH~ SmUCTURES ARE F~ ~ SPEOF~C PURPOSE ANO USE ~EREFORE THEY ARE
NOT INENOED m ~U~ENT ~E PR~ERTY LINES OR TO CUIOE ~E ERECTI~ ~ ~N~S. ADOI~ONAL SmUC~RES OR AND O~ER I~PROE~ENm EASEMENTS
AND/~ SUBSURFACE S~U~RES RECEDED OR UNRECORDED ARE NOT GUARANTEED UNLE~ PH~ICALL Y EWDENT ON THE PREMISE5 A T ~E ~ME OF SURLY
SU~Y OF: LOT 35 CERTIFIED TO: LONG IS~ND HOME BUILDERS;
~P o~: EASTERN SHORES AT GREENPORT
FILED: APRIL 27. 1964 AS
mo~ OF= SOUTHOLD