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HomeMy WebLinkAboutDodge /011 OFFaiir JUDITH T.TERRY ,��� . �� Town Hall, 53095 Main Road 1 TOWN CLERK ® ; P.O.Box 1179 �• et, . Southold,New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER ��� Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER --_ 40,06e Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER ,.�el OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3618-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner DODGE Mailing Address 1 C/O ELE DEVELOPMENT CORP. Mailing Address 2 P. O. BOX 1143 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 665 GABRIELLA COURT Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 000-000-0000 Tax Map No. section 108.00 block 4 lot 7.040 Cross Street ELIJAH'S LANE Issue Date: 4/30/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) Lo+- [ (to OFFICE OF THE TOWN CLERK cvFFa,ro'- Town of Southold , 0�� CQG Application No. 1.1r Judith T. Terry, Town Clerk .• ;' Town Hall, 53095 Main Road , • $10.00 - Residential P. O. Box 1179 $25.00 - Non-Residential Southold, New York 11971 O /�`� Telephone -gel.( (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ ( DATE 4Ji � Ig4— OWNER NAME: -1:::)CDCA 9 OWNER MAILING ADDRESS: Lc" 01a. bleiI l Q C+, OWNER PROPERTY ADDRESS: � l�►'Y1C.. OWNER TELEPHONE NUMBER: TAX MAP NO. : Section Block 4 Lot —1 . 4 O CROSS STREET: Et I :iprk 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 r• of Applicant RECEIVED BY: Town Clerk's Office DATE: s et' / — Z 00 'A � P sem, �ti �9 'apo, "7 _ SURVEY OF ,� 2.�2• - LOT 16 fir' "ELIJAHS LANE ESTATES, SECT. 2 FLED AT MATTITUCK TI TUCK 1996 FLE NO.9912_ � rr'P �, r �' - TOWN OF SOUTHOLD . G • SUFFOLK COUNTY, N.Y. s b B �ti3` 'A 1000- 108- 04 -P/0 7.1 < c e ,(J?1,TGR Scale: 1"= 40' �� '`? ,,y- Dec. 4, 1=994 996 Z\9 ��• a.• ,�.� • 05 `\ 1a' r S t T::�..►ZYi~:.S Z ��3� �� rr L:{t�L' Dsi'A�T.h1�Tr 'r..sA.• A O2 acs; Qj, a°^ P C��ii+a�ZAP ",1 /�+� Y ;= va/ � �i `y APPROVED G,p o wOR'vtA�i of�E��� FEB 19 1947 ir <I .-1-%.�� ^'pi S I'riRE'`�AR91"tCMDAIEOFAPPROVAL tec P � coeptuivisOSE �1 'p Zo .�-a� �E• yo 7.21Q10_ ^3° �. , AREA = 41,078 sq.ft \ ,a ACDIT,CA TO THIS SLRVEY CS A V, ATL^N ( an (caller with rhe STANDARDS r:OR APPROVAL The locations of wells and cesspools . 43618 ANY CT7ALCN 7209 OR y ANO CONSTRUCTIG OF SUBSURFACE SEWAGE RESIDFNCc$ and shownohereon data obtained field from servations/5��— •� ..,Z=.W - • OFSEr CF N . YORK STATE EALL C -aPEON1 SUR EXC�r ASP SECTION TZC�u.BC�H�N a ALL CE,,_ Tif7NS a dPwin mid Yby the :n aryls sal forth FAMILYherein and an !hs (516) 763 - V E HEREON ARE VALD FCR�ATO COPES ThOF 77- GAY Peril to conslrncl. P O. BOX 309 SAIDO ,'AAP CR COPES APPEARS NTH 7SASAC LAO SEAL OF T77E' ITRAI 'A St,RV£YCR ( i6) TRAVE0S STREET ANOIE HALL TURF He7£CN. £L_NAi7CNS ARE REFITFIKJ N.Y. 11971 AtrrF 3E USED 3YC AU. 5l,iiSS SL AA CCPYLrEqtat 3� TO AN Asst AR aA T E SOUTHOLD,SRCUGN CA ARE ;�� '' 96 — 317 16 7 • X tl IN /'( ' — 41— -7/ (-(?) 25 SP 17 21 �' SURVEY ,OF e ' "II LOT - 16L., • oP "ELIJAHS LAt,iE ESTATES SECT. 2 Ste. �r FLED OCT. 8, 1996 FILEN. 9912 �� 0 AT MATTITUCK - _ -o ® /`r0 OWN OF SOUTHOLD O T G � r ..! SUFFOLK© -. -ipCOUNTY NY 1 _: Z ( f41i/4,* `l� woo - 108 — 04 — P/O 71 j �s`P�7 ,3� Scale: 1"_ 40' Dec. 4, 1996 = ' s�{ s� 4 „ ) \. 0 7 Z- 7.-- 7 6/j . L „ _ .. __, ,..............,_,;-, 7, 2 • • SUFFOLK� s l DEPOF HEALTH SERV - ' „-.4 . .„ itc. '05 . . _ ,•.„;,_. - ~yi.. _�.ICES . • ;,_ :V u y PRR3T FOR APPROVAL Or C raucnoN FOR A - = ' • ';... :-,':�- ._,1,-: •. FA10�S,Y • 1r•. r ter: ONLY • • m : APPROVEDii 1 _ y 'dxs �.tj a._ 1n'A�n x R-.:„..2-7-.4,-,,_''iy''4;`•; . _ M1 y� h'�sa' `'`k.it= ;t''�' "Hfi^ev'. �t'r - !/� `y.• ai - .. �4 OF BEDRooms w+�:r:.x 3 r - > ;_ EXPIRES YEARS FROM DATE OP APPROVAL - '774k`;;&' 4frA ,x5;4. ,a1.0 4i ' e..1ls{ .%X_ S SR �`s '4%.1Yi .gi1 _�3.5: ae�y fr3.�s,5 Y ^� <i•C�F `r ir^#';� ��” .g<-3•,404,'",--- --Y--' ,- 'k f3"w v' ,Z,k�$ -Yi'^%v.;{.T,�,,,ar r{•v„�,,r;•: i�r_©f'NE p r _ _ - •'S dT.r7 ,�'�,� „ of 4...,,,,,,,,.„,,..„,,,,t,„: -.4-...,.."A-‘,rii,-,..i. t.,:;.;...f,--- ='-- s v\ ht 3 •:,.4"...'11‘''(.›.:;.. -,r,,:::'..1.'- • 1 'J �h'''s^ • £Sr, •v '.ss ,,p,=•h , '-•' •. i L ,s a ? �sc•k" fit// Pla -,--;` ,} P C ".+ t t ia44yl--'.4':+:.5; • ` ��^ - ,j*-' :rr-tea.,�T e