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ELIZABETH A. NEVILLE ��� Gy Town Hall, 53095 Main Road
TOWN CLERK • P.O. Box 1179
va Z Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Fax
��O�I,,, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4133-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner CAPECI,DINA
Mailing Address 1 205 E. 77TH ST., APT 5C,
Mailing Address 2
City St Zip NEW YORK NY 10021-0000
Property Address 1 400 CREENWAY WEST
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 631-345-6820
Tax Map No. section 15.00 block 1 lot 18.000
Cross Street PARK VIEW LANE
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Issue Date: 2/27/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
WN
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OFFICE 0 NOFSOUTHOLDE S�FFU�`pG Application No.11-/ 3
ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEWYORK 11971 $25.00 - Non-Residential
Telephone ,142 * Y1��� '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ttiNs
DATE
OWNER NAME: Q&p &L bJ ,
OWNER MAILING ADDRESS: D_t5-5 -mil-
lotto
'
OWNER PROPERTY ADDRESS: L Qt(ee. 1 Crkaf
OWNER TELEPHONE NUMBER: (111 -
TAX
p1 -TAX MAP NO. : Section Block Lot l
CROSS STREET: \1 1U) l atJ2-
TYPE OF SYSTEM: Septic Tank New 1. Existing
Cesspool ✓ New j4xisting
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.)
/46
° I igYjd-
7Sign ure o A,•licant
RECEIVED BY: •
own Cle 's Office
DATE: ADI (6)-----
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SURVEY OF
LOT 34
MAP OF
GREEN ACRES AT ORIENT
-,1 FILE No. 3540 FILED APRIL 13, 1962
LSITUATED AT
ORIENT
CD
TOWN OF SOUTHOLD
LOT ' ^f SUFFOLK COUNTY, NEW YORK
2 32a2foo
focE 0.0- 4.2,E. S.C. TAX No. 1000-15-01-18
,g , 0,+ .- of Vats F SCALE 1"=40'
• I a I N 6.40 5 ` 1/t DECEMBER 6, 1999
t FEBRUARY 22, 2000 REVISED SEPTIC SYSTEM
t) i \ (_. we MAY 26, 2000 RELOCATED PROPOSED WELL
1 MARCH 1, 2001 REVISED PROPOSED HOUSE SIZE
ZS •w .� AUGUST 17, 2001 UNDER CONSTRUCTION SURVEY
EpN 11 y i i; NOVEMBER 14, 2001 FINAL SURVEY
• r p AREA = 20,879.99 sq. ft.
'v 3 \ 1; mry o 43' 0.479 ac.
U
crlCERTIFIED TO:
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f
$ COMMONWEALTH
LTH LAND TITLE INSURANCE COMPANY, ,
..,.% L., ° o-a RAY CAPECI p . , cu-' -o ,
• DINA CAPECIy11111i t O
Eecft �xt. uSO28
• c003 $ g%
4100° UN ,
N
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a { 1 a` tik t't 6 4 • o
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f ` LOT 34 0
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0 v1 • Co 1 13 '4B' r
w1 RID oy ,PREPARED w ' . WIN NE WWII
t • ••., e 'Z�LL w0 •N u5E 1-4,-.. TORK STATE LAND
• \ S 162' LOT s3 df
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---'- N.Y.S. Uc. No. 49668
UNALTMORIZED ALTEPA11ON OR MORTON
TO TMS SURVEY IS A YTOLADON OF
SECTION 720e OF THE NEW YORK STATE
LAI
EDUCATION �W. seph A. Ingegno
COPIES of pas SURAET RAP NOT BOWINGI)* THE LAND Surveyor
r
SEN.SURVEYOR'S
INKED
BE coNsIDERED Lend Su veyo .
TO BE A vALD TRUE COPY.
E ONLYF1Oti HE P FOR NE SUREY
N ONLY TO THE
IS PREPANiD,AND ON HIS BE}iYF TO THE
TITLE oo1NsNN,CWE1GgIDITN.AOENCT AND Tide Surveys - Subdivision - Site Pies - Cansbuction Layout
1" T T E-w L LENDING Mi$ 7N USTED rem AND
V j � OF THE LENDING sors-
VIPPS.C�AnOt PHONE (631)727-2090 Fox (631)727-1727
P A THE OOSTENDE OF RIGHT OF WAYS OFFICES LOCATED AT AIMING ADDRESS
ANWOR EASEMENTS OF RECORD, IF
ANY, NOT SHOWN ARE NOT GUARANTEED. 1380 ROANOKE AVENUE P.O. Box 1931
RNERHEAD, New York 11901 Riiverhead, New York 11901-0985
9B-748D
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