HomeMy WebLinkAboutVogel, Joseph OFFICE OF THE TOWN CLERK c$We" `/
TOWN OF SOUTHOLD 0� COG Application No."VD S7
BLIZAB$TH A.NHVILLE,TOWN CLERK $10.00 - Residential 1>\_._P:O.BOX1179
(11
SOUTHOLD,NEWYORK 11971 *'; $25.00 - Non-Residential
Telephone t % r/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ • r
if
8.0
4 DATE
OWNER NAME: iR70
OWNER MAILING ADDRESS: 7) - / igoe,r, 4e
e
0;-enc. tatek, N'/ //y./7
OWNER PROPERTY ADDRESS: 0.24.1i% vri71 /
firmzat
/ llqs3_.OWNER TELEPHONE NUMBER: '/'� ' ' 2o'.o`t,r
TAX MAP NO. : Section 7°6 BI ck Lot f4-3CROSS STREET: S�rl "' dJ6C[ts�2.
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.)
Signature o • pp cant
RECEIVED BY: F
Town Clerk's Office
DATE: // 2 � �
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A, ‘•,'"SAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
and *1 ablde by the conditions 'set forth therein and on the Ant;
permit fa construct.
DateQCT
The Sewage di�yrted .l
S�C.DM�S REF. #RV—88— 0240 be 135�1QC C4'
ELEVA 770N• f ARE REFERENCED TO AN ASSUMED DA TUM.
The locations of wells and"cesspools
""shown Norton are from field observations i
and or from data obtained from others.
NOTE,
LOT NUMBERS ARE REFERENCED TO
944P OF SUNSET KNOLLS SECTION TWO' L0' ® L,1
FLED IN THE SUFFOLK COUNTY CLERK'S 0
OFFICE ON APRIL 9, 1970 C
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