HomeMy WebLinkAboutBower, Kathleen ELIZABETH A.NEVILLE I.I Ot‘.
Town Hall, 53095 Main Road
TOWN CLERK o • P.O. Box 1179
cia REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER �, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `;y_ l �a�����' 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. 4224-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner BOWER, KATHLEEN
Mailing Address 1 2740 MAIN BAYVIEW ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 12710 SOUNDVIEW AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-2055
-pax Map No. section 54.00 block 7 lot 1.003
cross Street HORTON LANE
issue Date: 10/21/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK c SCSFU(ir`;"
ETH A.NEVILLE,TTOWNCLERK o� Application No. u? �
U :t $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 cry cf; � $25.00 - Non-Residential
Telephone * Si"
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for --_ RECEIVED
OPERAT ION PERMIT 007 2 0
SEPTIC TANK or CESSPOOL
Southold Town Clerk
Operation Permit No.
Fee $ 1a - vv
DATE /0//6/ 3
OWNER NAME: 4<ot "el(--e ,e v\ 61-o-e_ tr-
OWNER MAILING ADDRESS: a'1 '-{o Vn a ( 130`1
LA `1 ( ( �C 1 (
OWNER PROPERTY ADDRESS: ( a -1 I u So u n d V
, t - `-J i ic, -1 I
OWNER TELEPHONE NUMBER: (L3 1 _ Co S a O S S
TAX MAP NO. : Section 5 I` Block -1 Lot t 3
CROSS STREET: 4 o - +-ay
TYPE OF SYSTEM: Septic Tank ✓ New ' Existing
Cesspool New Existing
Residential '� 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.)
Signature of Applicant
RECEIVED BY:
To n Clerk's Office
DATE:
ARTCO DRAINAGE CORP .
P.O. BOX 1132 MATTITUCK, NEW YORK 11952
(631) 298-9660 • FAX (631) 298-2291
Certificate of sewage dispose system by installer
health Dept Reference number R 10-00-0158
Suffolk tax map #: Dist: Sect(s) Rik(s) Lot(s)
Project name or Address: Horton's Lane, Southold
Subdivision Name&Lot#
Applicant's Name : Kathy Bower
f)escrIpt ion of system installed:
Septic tank
Volume (gallons ) 1000
Shape rectangle
Name of Precast manufacturer: Coastal Pipeline
1.caeliiiig Pools
Number of pools 5
Diameter and depth — 8' x 2'
Name of Precast manufacturer: Coastal Pipeline
Other
Attach or sketch below the measurements from building corners to the access covers of disposal
system.
I hereby certify that the subsurface sewage disposal system, described herein, has been installed
by me in accordance with the plans and standards of the Suffolk County Department of Health
Services: and is operational.
Installer Signature Date June 6, 2003
Artco Drainage Corp 631-298-9660
Consumer Affairs License Number 206W