HomeMy WebLinkAboutLicata ELIZABETH A. NEVI~,I,F,
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOR/X/ATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
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
l ~ $10~
Rcsidantia or Non-Residential ~ $25 __
Applicant Name ~ f~ T ~' "C~ (~t { /~
Applicant Mailing Address I (h I ? UD ~ ~ ~
Septic Tank r or Cesspool
Brief Description of Proposed Construction or Alteration
Application No. ~)~Q-q 7
Permit No.
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
Owner Property Address: ~ 0 _~-
Name and phone number of contact person % ,-~-~ ~x-59, ~
Section I_~ Block 5-- Lot ~
Tax Map
Cross S~-eet N~'~L ~tl~t9
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH It~ALTH DEPARTMENT APPROVAL
Received lJy:
s: ; eofA canC'
5UP-.VE"( OF: LOT 61 - -
Pi'AP OF: O~FFNT B"r' THE SF:A, .5,1=C. TiON Tl, qO
FILED OC. TO~ER 2,S, IqCI FILE No. 3444
SITUATE: OI~.IENT
TOi~N: .5~UTHOLD
5t)~=OLK, C, OUN~,
SURVEYED IO-2,~-O~
SUFFOLK COUNTY TAX #
NAT L~CATA
~ODY ~ICATA
Filed hdop
-o~; 60
rive~o9
150.00'
S88°26'00"W
ELEVATION5 REFERENCE $UFFOLK COUNTY TOPQ NAPS
GRAPHIC 5GALE I"= ~O'
JOHN C. EHLERS LAND SURVEYOR
6 EAST MAIN STREET N.Y.S. LIC. NO. 50202
RIVERHEAD, N.Y. 11901
369-8288 Fax 369-8287 REF.\kHp server\dLPROS\03-282.pro