HomeMy WebLinkAboutWalker, Warren ,, ,o� suF Fai,reoG
ELIZABETH A. NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK % o - P.O. Box 1179
H Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS 'oat, �1,�
MARRIAGE OFFICER ,L Fax(631) 765 6145
RECORDS MANAGEMENT OFFICER `ma "�/Q ��i , Telephone (631) 765-1800
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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. 4194-R Residential x Non-Residential
Fee $ 10.00 New x Existing
Name Of Owner WALKER, WARREN P.
Mailing Address 1 P 0 BOx 246
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 375 SOUTHERN BLVD
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 631-477-2010
Tax Map No. section 21.00 block 3 lot 27.000
Cross Street ROCKY POINT ROAD
Issue Date: 3/18/03 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
00
OKFIQEA)F TILE TOWN CLERK C51FO(,� I
TOWN OF SOUTHOLD ,, � �D Application No. / p
ELIZABETH A.NEVII.I.F,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEWYORK 11971 �' $25.00 - Non-Residential
Telephone _41 4 "R� �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: 63,,,„ti, p Ldol � / ,
OWNER MAILING ADDRESS: 12_0. goy 2y(0
Eas4 �� ; 'ri �cl Y I1 P3%
OWNER PROPERTY ADDRESS: 375- Soma r R Vd 6241
OWNER TELEPHONE NUMBER: -g7 G Er y`? '7 2 0 1 (7
TAX MAP NO. : Section O Z I Block 000 3 Lot 027
CROSS STREET: gc.,c a; �c,p•�
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.)
Signa re of Applicant
RECEIVED BY:
Town Clerk's Office t -7 7/
DATE:
•
-- --------
JOB No. 9926 ;'„?',',-:;:',-11 :,, TAX i.D. No. 1 X00-21-03-27
ALL DISTANCES TO WELLS AND CESSPOOLS
�'.i, 19 Fr`i I,. } I ARE BY LOCATIONS FROM HOMEOWNERS, 1
r r FIELD OBSERVATIONS, AND EXISTING
,- ' . ,y'.,`. SURVEYS. SINCE MOST ARE NOT VISIBLE
' ''ri �; E`� ;t'' THESE DIMENSIONS ARE. NOT CERTIFIED,
TAX LOT 25 TAX LOT 15
1 .
1
N 89°5T40"E 125.19'
Il i
COI - '�' I
i 4 105.0 102.4 1 i
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t ter Mi .�\_5 ! �� t j
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$ $ - I ,
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IkP1� ° INV 109.0 LP
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PROPOSED
73 .27.5 SINGLE FAMILY27.5' 1
`t
0
NTDZENKOWSKI r.OCC RES FF 113.3 •
XGAR 111.8
-p X •
o - WELL -
2 g
-I tar 1 ,
73 .< LOT 3
O OCC RES
D
✓ TIE 312.51' PROPr D
111.5
\l/\
WELL 1
06^1
S 86'49201W 125.00'
' i!
SOUTHERN BLVD [ 50' ] 110.9 1072
LOT 16
LOT 1OCG RES
OCC RES WELL NEAR R c.)ADLINE .
WELL NEM RLIADL$IE
1
ISEE FILE MAP FOR TEST HOLE INFO I .
ELEV IN ASSUMED DATUM FILE FILE MiIP No.7130171
Unauthorized alteration a:addition to ttia docuentk is I viol�Jn at Saalion 7209 LOT
-�+
1 of the New York State ts�UmbelLaw. �: 6.0 1
Certifications indkeAaQ attdA ofelr*Re psi tlr eRef II is pnpwed ��pp
1 and on he behalf A►tita fiMit7oarpaAy° and Lidding
O /kat ��� DARK
' Institutions listed hMson.ata'iRIsMailessi rtf tertseI it on or
subsequent meters. A i� T
Capias of this doourawenet belie*the prwt irMalttasai or embossed EA �R , 1 OWN
1 seal shah not be nor Matta wertwle
The offsets t or diaatrMiatia�'it teat l S tIQs pApps Vss am SUFFOLK NEW
1 for aspecdlcpurpose sati anis rales ekeeeiinektit&J theeelettonof" COUNTY,
1 tomes.retain wail.paste,VOA t 6 arrl�s.09.1opiii7 pf,of a+9Ndher
The coner a of rfphtdferees-saillor woori o et rowed,It sot aotlhvwn era S�DA'E: 4119/99SCAM: 1 rr" '
I not guaranteed.
CERTIFIED ONLY TO: ��O NEW Y49
WARREN P. W U — . NG.`GRAF DESTIN G. `- _
- - -- ,wWAD ''+ . .
icg.
By DEST1N G.G F N.Y.S.DC. .50087 4tizei .>
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