HomeMy WebLinkAboutGreenberg Leonard ELIZABETH A. NEVILLE
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
FREEDOM OF INFORMA~gN OFFICER
~~~~ SO~THOLD WASTEWATER DISTffiCT
OPE~TION PE~IT
Town Hall, 53095 Main Road
P,O. Box 1179
South0ld, New York 11971
Fax (631) 765-6146
Telephone (631) 765-1800
southoldtown.northfork.net
CESSPOOL or SEPTIC TANK
Residential ~ $10 ~ or Non-Residenffal ~ $25 __
Application No. Ja2 7V
Permit No.
Owner Mailing Address ~ I~. ~ 6'¢ / ] 3 ~- I
Owner Property Address /~.,_D. LO /~t'~ ~.n~L'~
_ ¢vclC //?5-3_
Owncr Telephone No. '[t~'"~/: ~.~t~'~' 7[0~, ~)
TaxMap. No: /00OSection ~ Block~_~
Cross Street c- ..hmn fir YE_
Please check each that applies: New Construction
Alteration to Existing System ~
Residential ~_ Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance .in feet from system to building
and closest'road. New construction may submit copy of survey with SCHD approval.)
Signature of Applicant. Date
Received by: ~
PIKE
STREET
Ld
390.36'
EC.O.4'W.
J
W
.f,C,O.3' W.
N. 74°22' O0"E.
0
0
[~ enclosed
~ I
over
shed
shed
0
0
100.00'
2 stor~
dwelling
14.4'
fd'piP¢~s. 74' 22' O0"W. ,97.91.
td mon
fd.mon.
fd. mon.
NOW OR PORI';'IERLY JEROME
TEe ex's(ence oT r'gl:;t oT way~ an~! or easementF
O.[ lr, ecordt if any~, not. shown are not guaranteed,
LOY AREA 0,593 ACRES