HomeMy WebLinkAboutPagano Joseph ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
· · ·MARRIAOE OFFICER '"
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
~OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Town Hall, 53095 MEn Road
P.O. Box 1179
Southold, New York 11971
F~x (631) 765-6145
Telephon~ ~31) 765-1800
southoldtown.northfork.net
Residential ~ $10 or Non-Residential @ $25 __
Applicant Namer-~ ,~..,O_..~ ~'L
Applicant Mailing Address
Septic Tank ,""or Cesspool
Application No. ~ak"~)
Permit No.
BriefDescfip~on of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: "-~',~O k
Owner Mailing Address: ~d9 ~o,k
Owner Property Address: ~_..o.~;'IC GQ,,. [.[~d~e
E }-4acto
Nme and phone number of contact person I_Q~4eo- ~e ~, ~k D
Tax Map No: Section %~ Block ~" Lot
NOTE: LOCATION MAe MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION ~QUI~S SURVEY WITH HEALTH DEPARTMENT APPROV~
Received by.'~~'~'
Signdture of Applicant
P~
SURVEY OF PROPERTY
AT EAST MARION
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000-~8-04-~1
SCALE.. 1'--~0'
O~K 23, 2002
NOV. ~, L~O0~p (rett Hele )
NOV. II, 2002 (prop. hse, )
LOT NUMBERS
FILED fl
FFICE ON ~
(~
P.O.N
.... "
AND CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL EYE'MS FOP SINGLE FAMILY
ond wil/ ob/de by th~ conditions set fo?th there~ ~nd on the
permit to construct.
The locotion of we/ts ond
from field observotion5 ond or from
ANY ALIERATION OR ADDITTON TO lNIg SUR~,~Y 15 A WOLAUON
~ ~CUON 7209 OF ~ ~W YORK SrA~ E~CAUON LA~
~XCEPT AS PER SECUON 720~-SU~IW~ 2. ALL ~R~CA~S
qEREON ARE VALID F~ ~lS MAP ~D COB/ES ~ ONLY IF
~AID ~AP ~ C~S ~AR ~E I~ESSED ~AL OF ~f SUR~Y~
~0~ SIVA ~RE APPEAR$ HERE~. ~
~LEVATIONS REFERENCED rO AN ASSU~ED DA~M. ~