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0004
JUDITH T.TERRY ��� .03: Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS ` �,
® I �, Southold,New York 11971
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MARRIAGE OFFICER 4 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER =�®1 +,i � Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ,.�o/
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION, PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3613-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner HAHN
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 1120 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 LI lot 7.027
Cross Street ELIJAH' LANE
Issue Date: 4/30/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
II
OFFICE OF THE TOWN CLERK c0Futii
Town of Southold Application No.'
Judith T. Terry, Town Clerk ,A
Town Hall, 53095 Main Road $10.001- Residential
P. O. Box 1179 Cr" .1.1.11, $25.00 L Non-Residential
Southold, New York 11971
Telephoneot
(516) 765-1801
TOWN OF SOUTHOLD
I
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee
$
11 II
DATE i '�T I �� a F 1-
OWNER NAME: r, '- k ►�
OWNER MAILING ADDRESS: 11 20 C_,- .-2_10V2_1 a I z C4--
Mzt~-+ t.cGz . / tS52_
OWNER PROPERTY ADDRESS: c4HYY1�.
OWNER TELEPHONE NUMBER: 4
TAX MAP NO. : Section 1 �% Block Lot 1 . 2-
CROSS
CROSS STREET: . 1 I j }' h S L 4=1-k)c_ i
TYPE OF SYSTEM: Septic Tank •J New Existing
Cesspool V New Existing
Residential Non-Residential
i
LOCATION MAP: Must be attached hereto before permit may Abe issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building andl closest road.)
Sig ure of Applicant
RECEIVED BY: I
Town Clerk's Office
DATE:
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262 F c•- ../...Oi . O.0 C2. ' 0 ....e ,--4
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/ \ �r - , LOT 22
"� "EL1JAHS LANE ESTATES, SECT. 2
L R•38.83' O� -;_r FLED OCT. 8, 1995 FILE NO.99V
0 AT MA T TI TUCK ,
\� o,�. ,/�e,‘ a TOWN OF SOUTHOLD
92 • SUFFOLK COUNTY, N. Y.
\'\ y2, /=' 1000- 108- 04 -P/O Z1
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Scale: 1"- 40'
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• \ �� Dec. 4, 1996
, / e,1:::7
z ? e v s��� // �0� SUFFO:d:COUNTY DS AI MINT OF HEALTH SERV .Rs
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O PBRB�T YO APSi1tJVAL O�CO? TRUC'TOi:POr A
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Z,A0DATE:EMIT; £1 s -_ a0
'4 sS' /Ot°\c APPROVED !' 4-
O / ✓20 MAXIMUMPOR. P EROOMS '
- / C
4r EXPIRES THREE YEARS FROM DATE OF APPROVAL
41/ ,;0
2
C' /-0- 5-h2 ��p� NEW 10
1* Z. 41/4‘..a S.mEr2a w r
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AREA = 40,781 sq.ft s - ..
ANY ALTAT7ON OR ADO/770N TO 770 SURVEY IS A V10LATiCN
1 om lardior with the STANDARDS FOR APPROVAL The locations of wells and cesspools . '` .- ^'o• dvb`6_C
-- of s£crloN 7zo9 of 77��s YORK STATE ExxA77oN LA/, AND CONSTRUCTION OF SUBSURFACE SEWAGE shown hereon are from /field observations i -x IC. NO. 449e%
EXCEPT AS PER SECTION 7209-SL60VISION 2. ALL CER777CAT/ONS DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and or from data obtained from others. "' •�`•\,!, �
HEREON ARE VALD FOR tTHE& AND COPS THEREOF ONLY F and will abide bythe conditions set lorlh therein and on the
VD VAP OR CCFES BEAR 1?£sPR£SS£D SEAL OF THE SURVEYOR PECONl�. SURVEYORS, P.C. �. '
-'SE SIGNATURE APPEARS FEREON. permit 10 construct 15/6) 765 - 5020 6/.? o1~'SULLY TO COA .Y M777i SAD LA•771E TERM ALTT-RED BY' - P. O. BOX 909 ` � \,' at
-USED BY ANY ANA ALL SLRVEYOAS J1VZDve A COPY EL£VAT NS ARE REFERENCED 1230 TRAVELER STR_ ,yc `�--
-7R SURVEYORS MAr TERMS StJd AS 'xsPECTED'A� To AN Assc74m DATUM • SOUTHOLD, N.Y. //971
3_DATc ARE NOT M COKLLUICE NTl?f ME UM. ,
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' '' " "ELIJAHS LANE ESTATES,• S� _.
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Y:xi- 'ss FLED OCT. 8, 1996 f10EM0. 99r�
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AT MA T TI TUCK
• TOWN OF SOUTHOLD
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Dec. 4, 1996
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FAMILY ONLY
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-.-.;:i.,,,...-....e.. .41*= � ram # • �po98 DATE FEB 21•
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t; � , e :",' X71 ilh lite STANDARD
.,ate ;; _��- . =} ' �: - am lower w�
S FOR APPROVAL The locations of wells and cesspools t . '0 496
• ,y` '< n :, = AND CONSTRUCTIONOF
�� a _w. ;., 1 : :. ictw C4 M, SUBSURFACE SEA • -
; r ¢:_ r ° ' ' ' ` '' '1 fR T�ow,s shown hereon are /le/d observotions / Y -+
;''- ter' 'v"' ` " EGF oar F DISPOSAL. SYSTEMS FOR from / / . 1
:- =>,;� {;:� � x ¢..-: SINGLE FAMILY RESIO C Sor '
-tea
m �. =`. F and from
{ and wirl obldi by-the con
Ports set forth_ therein an
om data vbtoined from others ifs
�$ x. .r ,� r-,v . and /he CONIC S -YEYORS,
:v, ti_�. perm!, -
lo construct. ,v,.•••• '�� �..�.�