HomeMy WebLinkAboutP M Construction Ent Inc , �, �SUFFOlit
ELIZABETH A.NEVILLE i�p Town Hall, 53095 Main Road
TOWN CLERK y Z ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O# t�1�'��, Southold, New York 11971
MARRIAGE OFFICER =
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ELIZABETH A.NEVILLE �i�`Z` � Town Hall, 53095 Main Road
TOWN CLERK p ; --P.O. Box 1179
t C4 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Ay t
MARRIAGE OFFICER : 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER , NA, ��). Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER - '� ' ,, I.'. southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 or Non-Residential @$25 Application No. / ° ' 1
Permit No. 3/ 7/ /z-
Owner
Owner Name F.iv. (' 'Jt.
Owner Mailing Address 8 WEW e-t/'//' i.4-tir
G g-'tE6ee "UV 7/7$Sf
Owner Property Address /0 Si S T.93-*t4/t L tie
e">QOr `y //9345'
Owner Telephone No. ((.3) 5 c--- qr
Tax Map No: Section g CC Block 44 Lot ) g 0 0 0
Cross Street _SGt QDL/ f'''4 Ce-
Please
tPlease check each that applies: New Construction ix
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.)
P-Aj4- /1Z7 5114./
Signature of Applicant Da
Received by:
EV
SOB No. 03-53 SEPTIC OCATIONS TAX I.D. No. 1000-33-04-29
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A. „..,,, 30 ilti to:
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LOT 43
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4 o N 64°31'50"E 142.32' [ACTUAL]
9 I GAR I
[142.14'FILE MAP]
x x — — —
WATER SERVICE
23' /--
+ CMM / COVERED
I I WOOD PORCH
23.5 �1
_�23' SEPTIC
co 6.3 '`—p
w "' 1 ST OH III'• C >
Z N aaii / : LP
/ N) (I)
La w / 2 ST FRAME N
$ o DWELLING 113 O_D c m <
F `* 04 7.
rfi n Z
O 0 WOOD DECK 12.0 17.8 GAR / ti°jy
N = < I_III ev 23.3 40' m Z
Z 17.0 . OO 73 m
CONC ENT i
DOWN
01
PROPOSED DRIVEWAY 0
40'
u
x
S 64°31'50"W 151.49' [ACTUAL]
[151.32'FILE MAP]
ISUFVaT.*COUNTY DEPARTMENT OF HEALTH SERVICES I D
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