HomeMy WebLinkAboutBenediktsson, Ben U
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ELIZABETH A. NEVILLE ���'_ y1: Town Hall, 53095 Main Road
TOWN CLERK ; CO3 Z ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS $ Southold, New York 11971
MARRIAGE OFFICER ft" y !`F,1� Fax (631) 765 6145
RECORDS MANAGEMENT OFFICER �Ol .������' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �������
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4050-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner BENEDIKTSSON, BEN & DIANE
Mailing Address 1 50 MYSTIC CIRCLE
Mailing Address 2
City St Zip BAYSHORE NY 11706-0000
Property Address 1 1655 EVERGREEN DRIVE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 631-665-6811
Tax Map No. section 102.00 block 1 lot 4.005
Cross Street DEPOT LANE
Issue Date: 9/25/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICETOWN OFSOTUfHOLDE S�FFO(i(�` Application No. 40 SO
ELIABETH A.NEW J.F,TOWN CLERK $10.00 - Residential
P.O.BOX 1179 cn `
SOUTHOLD,NEW YORK 11971 �1; $25.00 - Non-Residential
Off
Telephone _?10.� Y► i',•
.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION RECEIVE D
for SEP 2 2 2000
uNarhote fawn Clerk
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. a i Lai
Fee $ /01 '0. to.° D
DATE 9— /9—o v
OWNER NAME: j3flEdifcFbSQA1,
OWNER MAILING ADDRESS: „5-b
6 ,
OWNER PROPERTY ADDRESS: I ( 5 5 ' J —41V
Cictx_h,oce-e, ' . //R 3S
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section /0 es (,) O Block / Lot q, U o b
CROSS STREET: b ,pap-i-
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.)
" -io, - (-6 -64.4Ci
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
L iC 0 -,4 if
t(•N‘\,tC.-' ''. rA
., ,,,, "rs. ,,,_ i om fronabir van Ow STANDARDS FOR APPROVAL '.. 401f.
Su' 'R'C‘ AND CONS1RUCTON KO 11/11111URFACJE IDIOM
01IPOSAL SYSTEMS KV 111401E FAMILY REIODICES
ne\(3 t \C',C:i and val abide by be contitione oat forth awn*
° .t‘\• -• l'\'' and on Ow permit to aralnat.
SURVEY OF PROPERTY
or‘' The location of nolo and coospoolo
damn hereon ant from bald oboorrallono \ AT CUTCHOGUE 11
and or from dote obtaltiod tram Warn ..
TOWN OF SOUTHOLD
Lb., 90 SUFFOLK COUNTY , N. )
. IT' 9 eff
e 101, 1000-102-01--4.6
eAr 0
1#$" ®0.44) ,
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V SCALE: 1 mr 60'
PZB. 22, 1999
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L=39.27' ,
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Minimum distance between wen
and cesspool is to be 150 feet
CERTIFIED TO:
,7\ _2 .44) Diane BonodIktoson ,
LOT NUMBERS REFER TO*THE Bon Bonodlitsoon .\ce.pi N E IV yo.
WOODS AT CUTOICSOUr FILED V J.C. Land Abotroct Corporation
DC MO =TCOUNCLEICa
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IN 444'6
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OF10E ON MARCH 23. NM ASo, \
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