HomeMy WebLinkAboutCradit, LisaELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR, OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
6 OFFICE OF THE TOWN CLERK
p� 6k TOWN OF SOUTHOLD
L
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 or Non -Residential @ $25
Applicant Name A&A
Applicant Mailing Address�2
Septic Tank or Cesspool -,/
Brief Description of Proposed Construction or Alteration
6Q
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
/1 X '6%y ,/'90'y
Owner Property Address:
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
Application No. 42-62--
Permit
up7iPermit No.
y
Name and phone number of contact person
Tax Map No: Section 3S� Block / Lot
Cross Street
/1
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant Date
Received by:
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9
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SIN S )
(N Y S Rte-
UNAUTHOR12ED ALTERATION OR AM ON
TO THIS SURVEY S A VIOLATION Of
SECTION 7209 OF THE NEW YORK STATE
EDUCATION UW
SURVEY OF PROPERTY
SITUATED AT
GREENPORT
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-35-01-14
SCALE 1"=20'
JULY 11, 2005
NOVEMBER 22. 2005 UPDAiF SURvE` FOR DECK
AREA = 10,714.98 sq. it.
0.246 cc.
COPIES OF THIS SURVEY MAP NOT REARING
THE LAND SURVEYORS INKED SEAL OR
EMBOSSED SEAL SHALL NOT RE CONSIDERED
TO RE • VAIO TRITE COPY
CERTIFICATIONS NOICATED HEREON SN RUN
ONLY TO THE PERSON FOR W40M THE SURVEY
IS PREPARED, AND ON HIS BEHALF TO THE
TOTE COMPANY. GOVERNMENTAL ALENCY AND
LENDING INSTITUTION LISTED HEREON. AND
TO THE ASSIGNEES OF THE LENONC INSTI-
TUTION. CERMICATONS ARE NOT TRANSFERABLE.
THE EXISTENCE OF RIGHTS OF WAY
AND/OR EASEMENTS OF RECORD. IF
ANY, NOT SHOWN ARE NOT GUARANTEED.
C RTI aD..TO.
JEAN BUBB
=1 2 0 2C'
T i
PREPAREU IN ALCORDANCE WITH T4{ MNIMUM
STANDAAp$ TOR TITLE 5 AS ESTABLISHED
BY THE LI.AI.s AND NID ADOPTED
FOR SLKH USE BY TN TOFM STATE LAND
TITLE ASSOCIATION
of: NE
co QN A IA'
'k
4awLb NYS LiCNO_ 99668
Josep
A.Ingegno
Land
Surveyor
me surveys - Subd-slOOs
- Site aloes - co—t—'on t.oyout
PHONE (631)727-2090
Fax (631)727-1727
LOTED AT
OFFICES CA
MAILING ADDRESS
322 ROANOKE AVENUE
P.O. Bax 1931
RNERHEAD. New York 11901
R-.rheod. New York 11901-0965