HomeMy WebLinkAboutDunbar, Diane 41 -
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ELIZABETH A. NEVILLE �rrrh`t`� �4` Town Hall, 53095 Main Road
TOWN CLERK ; y ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v.
: $ Southold, New York 11971
MARRIAGE OFFICER O' i $ Fax(631).765-6145
RECORDS MANAGEMENT OFFICER �`44i aO�rrr� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - " 4I ,rrr 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 @ $25 Application No. 4 AO$
Permit No. @ ?4
Owner Name ►y. /A4/c.-'- /tV���7 .-..-
Owner Mailing Address i )() rw)C 62
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6(S' b-66-cook-Ab /,9 // z= Pme./0,6 ,tik( ((5-';
Owner Property Address '!S-/1-M
6WOob 69
Z%, 1-(/e I:4) /4('”
Owner Telephone No. `7 1 —/ s
Tax Map No: Section i'1 Block / Lot //
Cross Street
Please check each that applies: New Construction
Alteration to Existing System
Residential v' 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 op of survey with SCHD approval.)
fi7`/-Q3
Signat re of Applicant Date
Received by: P9
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SURVEY OF PROPERTY
AT EON
-4'F TOWN A T MARIH
OFSOU OLD
AREA = 18,655 sq ft. SUFFOLK COUNTY, N Y
1000 - 37 - 01 - 11
SCALE: 1" = 30'
CERTIFIED TO' SEPT 14, 2001
DIANE DUNBAR Sept 2Y 'e.c,/ %,-, 5,0)5
NOTE' LOT NUMBERS ARE REFERENCED TO
' GARDINER'S BAY ESTATES, SECTION TWO "
FILED IN THE SUFFOLK COUNTY CLERK'S
OFFICE ON SEPT. 23, 1927 FILE NO. 275
ANY ALTERATION OR ADDITION TO SURVEY IS A VIOLATION ��pF NEW yo
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. r�'\Q'��t.MerrO 94
EXCEPT AS PER SECTION 7209 - SUBDIVISION 2. ALL CERTIFICATIONS o Fy
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF / , ^�� `
WHOSEID MAP
SIGNAT�APPS EARRS HHEEREO/yESSED SEAL OF THE SURVEYOR /�yM"Q'6'7V Y .'LIC. NO. 496/8
ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM ALTERED BY' ECo �S 'Z'�';...r= , P
MUST BE USED BY ANY AND ALL SURVEYORS UTILIZING A COPY (6311 •,x► 0 0 X J 765 !797
OF ANOTHER SURVEYOR'S MAP. TERMS SUCH AS INSPECTED'AND r4.
BROUGHT - TO -DATE'ARE NOT IN COMPLIANCE WITH THE LAW. P. 0. • �F .9.
1230 i ' �' /ET
SOUTHOLD, 1L ;7ET
01 - 241