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Home My WebLink AboutMaguela, Norma• OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 or Non -Residential @ $25 Application No. " r3 2V Permit No. Applicant Name I11 L • t� 9--r T A - Applicant Mailing Address G_bbg Septic Tank__Vor Cesspool j n Brief Description of Proposed Construction or Alteration i� �b I Location of Proposed Construction/Alteration: Owner of Property:�� 10 Owner Mailing Address: 9 `7 _Z� /� *7-7-) Owner Property Address: Y,+A it - Name and phone number of contact person Tax Map No: Section Block 3 Lot Cross Street I C_ 1W A V` NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVE TH HEALTH DEPARTMENT APPROVAL b /vz 5 SiYnature of Applicant a Received by: L9 ELIZABETH A. NEVILLE °� Town Hall, 53095 Main Road TOWN CLERK c y� P.O. Box 1179 Z Southold, New York 11971 REGISTRAR, OF VITAL STATISTICS MARRIAGE OFFICER Fax (631) 765-6145 �� l Telephone (631) 765-1800 RECORDS MANAGEMENT OFFICER �$ southoldtown.northfork.net FREEDOM OF INFORMATION OFFICER' • OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 or Non -Residential @ $25 Application No. " r3 2V Permit No. Applicant Name I11 L • t� 9--r T A - Applicant Mailing Address G_bbg Septic Tank__Vor Cesspool j n Brief Description of Proposed Construction or Alteration i� �b I Location of Proposed Construction/Alteration: Owner of Property:�� 10 Owner Mailing Address: 9 `7 _Z� /� *7-7-) Owner Property Address: Y,+A it - Name and phone number of contact person Tax Map No: Section Block 3 Lot Cross Street I C_ 1W A V` NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVE TH HEALTH DEPARTMENT APPROVAL b /vz 5 SiYnature of Applicant a Received by: L9 SURVEY OF LOT 35 AMENDED MAP OF MATT17Lk,-K HE16HTS PROPERTY OF 6USTAV BAYER f9led _4 24,1456 as Map N6.1154 SITUATE: MATTITL" TOM, SOUTHOLD SUFFOLK WiNrY, NY SURVEYED 646-2000 SUFFOLK COINTY TAX V 1000-159-;1-12 CERTIFIED TO; C44RISMLA GJ-0R6AK0P0UL05 A W.)RHA HIN61JELA C0te40WIEALTH LAND TITLE INSURANCE COMPAW • HOWMENT AREA x 1-900 5F OR 0,11 ACRES 6RAPIfIC, 9 -ALE I"= 20' I o' Sm - iso 3S r .0op 000 - S 4-4 ON i ral JOHN C. EHLERS LAND SURVEYOP, 6 FAST ldk[N STRHRT N.Y.S. 11C. NO. 5D202 RMPIMAD, N.Y. 11901 369-8288 P x 369-8287 REF. -%'Hp scrvcy%dU'R0SQ0-=.pro m 06/04/2015 3:19 PH FAX 6317656145 SOUTHOLD TOWN CLERK [a] 0003/0003 M"l V-� � U Q / O'� IS9 -- -3 - /a