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HomeMy WebLinkAboutHauser ,� ��®gOFFO��Oo JUDITH T.TERRY a °� G���� Town Hall, 53095 Main Road TOWN CLERK ; y 2 ; P.O. Box 1179 na Southold,New York 11971 REGISTRAR OF VITAL STATISTICS %:?' 4 $ MARRIAGE OFFICERy� I16 O� Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER _ Q( Fax (516) 765-1800 FREEDOM OF INFORMATION OFFICER ,�iffig °�� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3631-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner HAUSER 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 1570 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 7.030 Cross Street ELIJAH'S LANE Issue Date: 5/15/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK c3IFO(•,(' Town 4of Southold Q� Application No. Judith T. Terry, Town Clerk �� ,. ;:, . ' " t Town Hall, 53095 Main Road �C $10.00 - Residential P. O. Box 1179 �� $25.00 - Non-Residential Southold, New York 11971 O O-%7 Telephone Yo.( (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL'"DISTRICT • APPLICATION for OPERAT ION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE L41•17 , q OWNER NAME: OWNER MAILING ADDRESS: IFJ 7© C� �JO►� �- s M z-k-ar-i -hAC k { N• 1( L l c SZ OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: TAX MAP NO.: Section I OBlock 14 Lot • 7. 3O CROSS STREET: EA < 1 19rh • re-- TYPE OF SYSTEM: Septic Tank •1 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.) *7./ Sig re of Applicant RECEIVED BY: Town Clerk's Office DATE: 1 ° . • \\ ,+n,: "-'-, :.=•,% I• L I ��= i The locations of wells and cesspools P� �� . ; shown hereon are from field observations / �O \ 17 and/or from data obtained from others. 3fdliCp C7LG i Sen r=3.. ELEVATIONS ARE REFERENCED • tea, 2`� gym. '� `ro AN ASSUMED DATUM O. L11-57 ,( P 11‘,..,1,' mss 9[.tFPEXX canon JAZ T C? ALTh \ 0'n '0i/ 7�C�AP )yAL LTA COl�lf>Vi C1�3I1!OR A -. A., 1.... Pte! ' �ICi3 YA, .3 �'R'j CIdY - .2 — ;7 -G7..00 !, 'V AppRovial W. G• MCPIRSS,r YEARS FROM DATE CP APPIOVAL 20 - 9 \ a• ' , \ SURVEY OF LOT 25 -7 ` a Y� r a'v "ELIJAH'S LANE ESTATES, SECT. 2 " y' - FILED OCT. 8, 1996 FILE NO. 9912 -A� "� \ ;` AT MA T TJTUCK • TOWN OF SOUTHOLD \,..... < �0n �7\ Lu ��,, SUFFOLK COUNTY, N. Y. "9 0• ' `,. woo - 108- 04 -P/O 7.1 o Scale: 1"= 40' \ p Dec. 4 1996 c • Q 2.0 - AREA = 41,345 sq.ft. -p c `\ o . �\ �j tam familiar with the STANDARDS FOR APPOVAL t.n t ^'� ) ANY ALTERATION OR ADOITiON TO THIS SURVEY IS A VIOLAT7oN AND CONSTRUCTION OF SUBSURFACE SEWAGE ., i i ?+ r_ OF SECTION 7209 OF THE NEW YORK STA TE EDUCATION LAM. DISPOSAL SYSTEMS =OR SINGLE FAMIL,' 4ESIDE.VCES r "� "' LY . LIC. NO. 49618 EXCEPT AS PER SEC710N 7209-SUBDIVISION Z ALL COF 0H[ATIOhRS . \ by . hEREON ARE VALID FOR 7 iS WAP AND COPES THEREOF ONLY IF and will aoide by the conditions set forth 'herein and an ohe SAID MAP OR COPES BEAR THE MPRESSED SEAL OF THE SURVEYOR \ permit to construct. ' 'EC,..', R i ,�."•. P.C. CHOSE SIGNATURE APPEARS HEREON. '516; J1 ADDITIONALLY To COMPLY 117TH SAID LAW THE TERM ALTERED BY' P. O. BOX , id MUST 3E USED BY ANY ANO ALL SURVEYORS UTILIZING A COPY 1230 7RAVELER STREET OF ANOTHER SURVEYORS MAP. TENDS SUCK ASNSPECTED'AND SOUTHOLD, N.Y. 1197! •BROUGHT-TO DA T E'ARE NOT N COMPLIANCE M7TH THE LAW. - 96 - 317 25