HomeMy WebLinkAboutGladitsch William F,r,IT,~,BETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS iV,_ANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sout holdtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
Residential ~ $10
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Non-Residential @ $25 __
Applicant Mailing Address ~¢b4-
Septic Tank /~'-or Cesspool
Brief Description of Proposed Construction or Alteration
Application No. '~'~' !
Permit No,
//7/9--
Location of Proposed Co~7¢tion/Alteration~//) ,'
Owner of Property: ffJ//~ ~
Owner Mailing Address: ~& ~~ '~.
Owner Property Address: k.~O * ~-.~ y~.~
Name and phone number of contact person ~
TaxMapNo: Ioo0 Section ~ ~ Block ~.~
Lot ¥./5
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
Received
t~
0
Survey for:
WILLIAM ~a~; COUNTY
Lo~
13,
At
Ma~{t~ck ,~EPT OF HEALTH SERVICE~
OFFICE WASTEWATER MGH'
Town of
Southold
Suffolk County, New York
S.C.T.M.: 1000-099.00- 03.00- 004.013
30 0 .30
SCALE: 1 "=.,tO'
NOTES:
1. AREA : 25,000 S.F.
2. · = MONUMENT FOUND, ,~ = STAKE .FOUNO,
,3. SUBOIVISION MAP FILED IN THE OFFICE OF THE CLERK
OF SUFFOLK COUNTY ON OCT. 16, 1981 AS FILE NO, 7019.
DATE: SEPT. 05, 2002
JOB NO: 2002-441
),.
CERTIFIED TO:
WILLIAM GLADITSCH
DAVID H. FOX N,Y,S,L,S. #50234
FOX LAND SUHVEYINC,
PO BOX 224
SPEONK, N.Y. 11972
(631) 325-2902
DWG: 2002-441