HomeMy WebLinkAboutScannell Maurice TOWN OF soLq~O~LD
P~), ~OX
SOI]THOLD, 1~ YOR~
TelePhone
(63.t) 765-1800
Applicatio. No.
construction
Alteration
$10.00 - Residential /~
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
AP,PLI,C,ATIO N
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
APPLICANT NAME:
APPLICAN~r ADDRESS:
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION':' . OWN'ER~OF PROPERTY:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: ~/~' -- ~0~
TAX MAP NO.: Section O~ ~ Block Om [ Lot_ o(~ ,
CROSS STREET: ,/~r ~,{~,V't e. ~.~j ~/',
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY:
· Tow~ Cl&rk's" Office
DATE:
AREA: 20,255 S.F. = 0.465 AC.
ELEVATIONS ARE IN ASSUMED DATUM.
NO SURFACE WATER EVIDENT WITHIN JO0 FEE~.
I SUFFOL~ ,7: ~ ]NTV DE?AR~v:~,]T OF ~-i~,~ALTH SERVICES~
,, , , ..... ~, TOP sOa
~OLK CO~; DEP~ O~ iCLA.L~ S~8 SAND
ROAD
~ TH~ADJOINING ~LS MAINTAINA MINIMUM ~00'
SEPARATION FROM PROPOSED CESSPOOL
SURV~ OF FILE NO. JgoJ CERTIFIED TO:
LOT ~ MAP NO. J72J ~AUmCE S~NNELL
~' FEB. 20, 196J PATRICIA SCANNELL
MAP OF REVISIONS:
STRA TMORS ESTATES u~o~r[ ~/o~/2oo~
SITUATE AT
TOWN OF SOUTHOLD
SUFFOL~ COU~, NEW YO~ PROFESSIONAL ~ND SURV~OR, P.C.
SCALEr 1'~50' OATE: JULY 19, 200~ -- SUCCESSOR TO -
~SEMEN~ ANO/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE PROF~SIONAL ~ND SURV~ORS
~H[~O~ SURv~CU~AN~EO UNLgSS ~HYSiCAL~Y ~O[N~ O~ ~E ~eE~iRES ~T TH~ n~E OF ~/~ ~T~~~~ NORTHSTAR SUR~NG,
GUARANTEES INDICTED HEREON SHALL RUN ONLY m THE PERSON(S) FOR ~HOM PAUL ~ CANALIZO, L.S., ROBERT A. ~RC L.S.
THE SURV~ IS PREPAREO, AND ON HIS BEHALF TO THE TITLE COMPAq, ~ GOQD GROUND SUR~ORS, P,C.
SPECIRC PURPOS[ AND USE AND ~ORE AR~ NOT INTENOEO TO GUID~ ~E~ PHONE: (6~1) 728--5~30 PHON[' (6~1) 878~0120
ERECnON OF FENCES, R~imNC W~LLS, PO0~, ~nos, P~Nn~S ~R~S, FAX: (6~1) 728--6707 F~: (6~I) 878-7190
~oomo~s m BU~LO]N~S ~NO ANY 0~ CONS~UCnON
~P NOT B~RIN~ THE ~ND SUR~ORS SI~TURE AND RED INK OR EMBOSSEO
¢~L S~LL NOT BE CONSIDerED A TRUE VALID COP~ COPYRIGHT - 2002 PAT ~ SEC~FICO P.L.S., P.C.