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HomeMy WebLinkAboutLicata, Nat (2) I�,�•�SUFFOL j. D • ELIZABETH A.NEVILLE ,+'���� G* Town Hall, 53095 Main Road TOWN CLERK a - P.O.Box 1179 + _ Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ' MARRIAGE OFFICER ,j. 1�s��, Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ';�Ql $ )+i• Fax (631) 765-1800 FREEDOM OF INFORMATION OFFICER _ .••• southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4266-R Residential X Non-Residential Fee $ 10.00 New x Existing Name Of owner NAT LICATA Mailing Address 1 1018 OCEAN AVENUE Mailing Address 2 City St Zip BAYSHORE NY 11706-0000 Property Address 1 695 RYDER FARM LANE Property Address 2 City St Zip ORIENT NY 11957-0000 Owner Telephone No. 631-667-5352 Tax Map. No. section 15.00 block 4 lot 8.000 Cross Street UHL LANE Issue Date: 9/28/04 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) Vir ,,s, �suFFo��:4 ��� ;\ ELIZABETH A.NEVILLE 00 o 4 ; Town Hall, 53095 Main Road TOWN CLERK 1 P.O. Box 1179 ae REGISTRAR OF VITAL STATISTICS �yy Southold, New York 11971 MARRIAGE OFFICER '� 1� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER = �'�� Fax (631)765-1800 FREEDOM OF INFORMATION OFFICER ei .1,v0'11 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential $10 i1 or Non-Residential $25 Application No.4L2 6 @ @ pp ra Permit No. 3 ©Q-7 5 Owner Name 111,4 "1" L / G Owner Mailing Address /0 1 O C' /422/ _ et-ti / 17 0 (1 Owner Property Address CO 9 5 7 y cj�eKrA-K J7 .LL a �Rterf , N . Y. ( , 5 5 - Owner Telephone No. ( Co (n 1- 5 3 5 02 Tax Map No: Section I C Block if— Lot . 000 Cross Street U H QAI e Please check each that applies: New Construction Alteration to Existing System Residential )( Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) v , ` / r ° r. 3 ft Signature of App icant Date (--6110(k - Received by: r, l0 1 i I Pr d well IOC. ' N vll1 SePtw - . el IS' \ • to el. 15' \ el. 16' 1 \ 588°26'00"W 150.00' dwelling L. S2 1 \ dwelling \ \ \ 4 \ test hole Test Hole # 4 From Filed Map CP lop Son \ \ l . Loam \ / \ Clay \ 1 6 -"-"-'•c_-- __- _ .._.-.--. --._..------ _ well Sand I _^H 1or Y1-2-,I,,'- L.'r% } " t� ly�` ar' Yj 1. .ff 1�1 �r1/4%--------:-----:," '�,o' `ll---- l` 7,: :- w r --7.=„,-77:,1',,7:: C v L'"LL I! . ______4117--:.`21).2 1�'.../ \,,- 1/4 -�'1.,. `-� ':D t M ,'arki5to Erlrc NOTES: _ t `l�' ID .) t r o A Y'i[.'.'w•J 1.1 L..iI Ci:�i�t':`.�'�i DATE v�!�i`:.�ii+ ►jam \ l • MONUMENT �ert,wa ,ia�ated a ea .wry tet ttih Ktig Lode a M1trtwe for Lord sways adopted tr �� Pel-`) q n.,New York State Assoc...a f+ae...vow Lma 5i..pe s:on Sold cn tiv,s wads I Mil p o PARCEL RESIDES IN ZONE DISTRICT R-40 �0ot °p the pa e„war e a„„e s p aurone (SETBACKS BASED ON NON CONFORMING LOTS) n�un..�rd.antt, caeie,,,,a.er,me�- tui agency and`etMi g i4M1‘ov iyted I er oon and e the assignees the Nsncliog...Won Gomes Vo-. tia.�.tee rnt tr»�sr erre t.,tervti,�t,i estiwtK..e 1 I ELEVATIONS REFERENCE SUFFOLK COUNTY TOPO MAPS JOHN C. EHLERS LAND SURVEYOR AREA = 22,500 sf or 0.516 acres 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 GRAPHIC, SCALE 1"= 30' RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF.\\Hp server\d\PROS\03-282.pro • iO 4