HomeMy WebLinkAboutO'Brien VfFO(,���o
a ELIZABETH A.NEVILLE _ y� Town Hall, 53095 Main Road
TOWN CLERK co y a P.O.Box 1179
REGISTRAR OF VITAL STATISTICS
Southold, New York 11971
MARRIAGE OFFICER y ®�� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �01 �� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER � southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4248-R Residential X Non-Residential
Fee $ 10.00 New X Exi sti P19
Flame Of Owner - 0°BRI EN, JOHN J
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Mailing Address 1 PO BOx 363
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Mailing Address 2
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City St zip LAUREL NY 11948-0000
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Property Address 1 350 LAUREL WAY
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Property Address 2
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City St zip LARRUL NY 11948-0000
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Owner Telephone No. 631-929-3051
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Tax Map No. section 125.00 block 4 lot 24.019
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Cross Street LAUREL TRAIL
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issue Date: 3/17/04 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
OJFICE OF THE TOWN CLERK �/
TOWN OF SOUTHOLD 0�� �Oj Application No. y �aZ
CLIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential
P.O BOX 1179
SOUTHOLD,NEWYORK 11971 V-51 • $25.,00 - Non-Residential
Telephone 'Oj y►���
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /®, do
DATE 3b o
c
OWNER NAME: ,A T, 0,6R ( r A)
OWNER MAILING ADDRESS: P.O. 96X563
1-1►0Rf-L , /V." It 51if 5
OWNER PROPERTY ADDRESS: :3,TO
OWNER TELEPHONE NUMBER: 631- 9,2 ? - 30s'l (63) -63c7-#20y)
TAX MAP NO. : Section /;?!�'•ao Block y- Lot a�,®1
CROSS STREET: L,go/Z!?- L 7TP-,.3-/L
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential X Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
4
igna re of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
OT
- VA�ANr 00,
4.
9 Y"
" F• ro s o �Fj.
N. ?6.44
842 ,Al �'� s 52
Building .4
U� B°X SURVEY OF PROPERTY
pA 29-7 00, AT MA TT/TUCK
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
1000 - 125 - 04 - 24.19
N� `37 �° SCALE 1" = 30'
o JULY 17, 2002
O o_ ` ,� JUL Y, 24, 2002 l foundation I
31A
99'y� The locations of wells and cesspools
shown hereon are from field observations „
and or from data obtained from others.
CER TIFIET TO,
JOHN J. O'BRIEN `\ 3' NO TE:
EILEEN P. •O'BR1EN C� i� LOT NUMBERS REFER TO "MAP OF
\ �` •�` LAUREL LINKSO FILED IN THE
SUFFOLK COUNTY CLERK'S OFFICE
ON NOV. 23, 2001 AS FILE NO. 10712
AREA = 31,299 sq f# S
' aNY'AL tERA77ON OR ADDITA* TO„THIS SURVEY /S A VIOLA TION mss �• -fl
f3F_SECTION 7209 OF THE NEl[� XORK STATE EDUCATION LAW. S 1 am familiar with the STANpARDS FOR APPROVAL
--£XCEPF AS PER SECTION 7209 : SWDIWSION 2. ALL CERTIFICATIONS: �"^� AND CONSTRUCTION OF SUBSURFACE SEWAGE
HEREON--ARE VALID FOR THS:MAP AND;COPIES THEREOF ONLY IF {
DISPOSAL SYSTEMS FOR SINGLE FAM/L Y RESIDENCES N.a:S LIC NO. 49618
' - SAID MAP OR COPES BEAR•T�l�'.I�NPRESSED SE.IL QF' THE SURVEYOR - ��� ”' � �
WHOSE SII MTURE A_PPF�IRS HFREOM - ` and will abide by the conditions set forth therein and on the <� / -
permit to construct. RS P.C.
• ADDIT)DNALLY TO GOi1P'i:Y•)PITH •Ssi,'D LAW_TERM 'ALTERED BY ' �
MUST.BE USED BY ANY AM ALL SURVEYORS UT�V6 A COPY ! 7��L$1Fol
FAX 16311 765 - 1797
OF ANOTHER SURVEYOtZ'S MAP. TERMS SUCH 't N/SPEGTED -'_AND P:
EROU6,HT _ To - DATE 'ARE NOT W COMPL14NBE WITH THE LAW. 1230 TRAV'EL'ER STREET
SOUTHOLD', N.Y.' 11971
02 - 231