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HomeMy WebLinkAboutFlorsz, Robert A A,%S�FF014 ELIZABETH A.NEVILLE ,i$14`� \ Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 Z Southold New York 11971 REGISTRAR OF VITAL STATISTICS V. Al ' MARRIAGE OFFICER O � Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER - y O�ileg Telephone(631) 765-1800 O' FREEDOM OF INFORMATION OFFICER ' ‘.411 #,,'' southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 /or Non-Residential @ $25 Application No.4/o2e� Permit No. Owner Name E avid W Y ,Jc F - i ZS 2, Owner Mailing Address (070 ies • Ma tf i'-f-kok N y 11152. Owner Property Address (0 70 11,6reS4 -Dr Mt�l' Ny jlgtiz- Owner Telephone No. 6.3/ ? isq ?-6 Tax Map No: /Jai) Section /1 Block /3 Lot t Cross Street tkt4) ucf=1(k Ave-- Please check each that applies: New Construction Alteration to Existing System x Residential )G Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system.to building and closest road. New construction may submit copy of survey with SCHD approval.) Ai 1/ /, 77S3 . , ignature of Applicant ate Received by: N x • • AYENU� x • a • - l':::: tJ� A • W i • • • . 0.4 00 14 44 CO t • f:4 E E N •,..1- _ OOE I ti V\ '441b‘')A, LLIT‘ ii I i. r f' NOTE: • } I . t:- •:MONUMENT Lot sued/vis/oN NAP f/GED IN THE Off/� 7 4 OF TIlE CLOP Of SIJFFO, C4'TV 0 JAN. ZS, /965 AS NAP NO4256. i 5.87.e/91201E.\ • -,s. — 1l51" ' [ l { jc.s:...,((pp s! O _6 �s c' • lc , , U ..,....... , . .....b �j'o.. 7 •+ 1 \ REVISIONS YOUNG • Q ~ `\\ r~I!' ; : h j.. `-. 404. Mq/970 400 OSTRANDER AVENUE. ' ` a s. 1 h k h OCT.4,1972 Q sw*.is. x r �' _ 1 `a . ALDEN W. YOUNG • _- (i. • h ha** !U \\ , \., .� \ PROFESSIONAL ENGINEER ANO V L.T F.,,,„ \ ; ��(.r \` LAND SU$VCYOR. N.Y.S. LIC. ,s ,12043 a . v qJ 'v1) ' 2e_`-tr_ss.a• Z.c SURVEY FOR: 0 • t7.1 , *4'= Q GARY ETTLEMYER 8 V IRG • N • m . I 711 w (f) LOT 15 u DEEP HOLE CREE k z Q• I. - (4 ct{ I (n, AT 1.... 1 MATTITUCK r- SPS i.o;i f��� i.� izi + /4187./9'20"w. /82.00 , .' TOWN of SOUTHOLD I . Li Lot /4 SUFFOLK CO., N.Y. SCALE: j 11 = 40' 1 DATE:JULY I