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JUDITH T.TERRY ; ��: Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
,� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ;_ ��,�/ Fax(516) 765 1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER = #91 .0000 Fax
(516) 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. 3620-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner HOGGE
Mailing Address 1 ELE DEVELOPMENT CORP.
Mailing Address 2 P. O. BOX 1143
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 2060 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 7.047
Cross Street ELIJAH'S LANE
Issue Date: 4/30/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c�UFF�(`( --
Town of Southold , • N , CQG Application No.lie_
Judith T. Terry, Town Clerk �� ;•-$k };•.; ,% y
Town Hall, 53095 Main Road -< I $10.00 - Residential
P. O. Box 1179 ": ' .:,, ;' $25.00 - Non-Residential
Southold, New York 11971 O ��
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Telephone ( 1►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE • ill 'n'l 3-
OWNER NAME: 059
9 C_.
OWNER MAILING ADDRESS: J Z- (., O Cy2.6 re.i _1 I C-+
M24-4- +-.A G k I N• `t ( lckZ
OWNER PROPERTY ADDRESS : Kir m
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 1 O9 Block 4 Lot -7.4- 1
CROSS STREET: E 1 JPrk5 LA S
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.)
ignatu .f Applicant
•
RECEIVED BY:
Town Clerk's Office
DATE: •
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d -p �, SURVEY OF
LOT 1
-7
-att "ELIJAHS LANE ESTATES, SECT.
i <� h cis FLED OCT 81998 FILE NO. 9912
, � ., AT MA TTI TUCK
° TOWN OF SOUTHOLD
Si?' 92 \ /O
ti �. SUFFOLK COUNTY, N. Y.
,_ \�� i1 , 1000 - 108- 04 - P/O 7.1
f ; \� ���� �� r •
Scale: 1" = 40' \
s ,��; ,c--c\ Dec. 4, 1996
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. 4c c o ,I\92° ,0 ! -FOR M�1XIIti3[3M OF_-_-_-1.
�' '"'�+ 5• Q P►O j LRES T YEARS FROM C
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OF i
•1!• S� �N T.M
FEB 3 -, 1�����f�f IJJ0009gq �- ���• O 'O'�'
PUffogr CO.
Envro,A; r4Q,278 sq.ft. f �0
ANY ALTERATION OR ADDITION TO THIS SURVEY LS A VIOLATION I am familiar with the STANDARDS FOR APPROVAL The locations of wells and cesspools O(AA
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAM, AND CONSTRUCTION OF SUBSURFACE SEWAGE shown hereon are from field observations
EXCEPT AS PER SECTION 7209-SUBDIVISION 2 ALL C£RTFICATIONS DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCESN.
HEREON ARE VALID FOR 17fS-MAP AND COPIES THEREOF ONLY I< and or from dols obtained from others.
SAID MAP OR COPIES BEAR THE AI(PRESSED SEAL OF THE SURVEYOR and will abide by /he conditions set forth therein and on /he
HOSE SIGNATURE APPEARS HEREOAL permit to construct. PE ON/C SU YORS,
'W
ADDITIONALLY TO COMPLY N7TN SAD LAW THE TiER11AL rFJtED BY' (5161 765 - 5020
MUST BE USED BY ANY ANC ALL S1.PVEYORS UT��g A pY P. O. BOX 909
OF ANOTHER SURVEYOR'S MAR TERMS SVCS aS INSPECTED'AND ELEVATIONS ARE REFERENCED 1230 TRAVELER STI
BROUGHT-TO-DATE'ARE NOT M COMPLIANCE p7TH THE LAA: TO AN ASSUMED DATUM SOUTHOLD, N.Y. /I:
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