HomeMy WebLinkAboutHolzer, Robert (2) SO(/r�o
ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS G �r
Southold New York 11971
MARRIAGE OFFICER �p Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER CQsoutholdtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4296-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner HOLZER, ROBERT
-------------- ---------------
Mailing Address 1 3385 MINNEHAHA BLVD
------------------------------
Mailing Address 2
------------------------------
City St Zip SOTUHOLD NY 11971-0000
-------------------- -- ----------
Property Address 1 3385 MINNEHAHA BLVD
------------------------------
Property Address 2
------------------------------
City St Zip SOUTHOLD NY 11971-0000
-------------------- -- ----------
Owner Telephone No. 631-765-1539
------------
Tax Map No. section 87 block 3 lot 10.001
------ --- ------
Cross Street NOKOMIS
------------------------------
----------------------------------
Issue Date: 12/06/05Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
. 1
EI.fZABN"i'S A.NZVHJX Town Hall,58096 Nunn Road
79M C 110M P.O.Hoz 1179
RZGW1VM.'O ` AL STAT2MC8 Southold,New York 11971
H OVVK= Fam(881)786-8145
RZOCM i8 a#AN OFFICES Telephone(681)786-1800
FREEDOM OF U0102MATION OFFICER southokkawn.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERAUT
CESSPOOL or SEPTTC TANK
Residential @$10 or Non-Residential @$25 Application No. 2
Permit No. 3 O-7
Owner Name
Owns Mailing Address 33S-5'- M Wt3e HA i4A, f-4-VO
SOAz143�-o
Owner Property Address E- A-A
Owner Telephone No. 7& s- /5 32
Tax Map No: Oct 3 Section -7 Block 3 Lot 10
Cross Street /U 6 xa M ► S
Please check each that applies: New Construction 914—
Aheration to Existing System
Residential Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance m feet fiam system to building
and closed mad. New construction may submit copy of survey with SCHD approval.)
i
16,�
Signature Applibaie
Received by:
9�Ty
SURVEY FY OF PROPERTY
AT LAUGHING
TO SYN OF TRRS
�' SOUTHpLD
�S'UFFOLKCOUNT
1000 Y N. Y.
--87-03-101
N.
SCALE.-
JUNE 7, 2004
OC r.
S, 2004
DEC.,VOV 6 2004 (ADDI T7ONS)
2004 (F?/O 17V LOC.)
4UG. 2005 (FINAL)
o IL
o p
�• �, -o p
O �x 'cP
� o_
LP
• �Q
'20-Q F �•Q
' ry ��.' C� �� �� L� `2.96•
2
sr04
4,05
TE,SiTi°HOLZ
a- 10•
Ar c tiG,
4, O
� !�8• BRONN ANO PALE-71.7-Y,AAA S,
is r
-= VA7Fjp py PALE BROiNy 9L7Y
SAND S/
—— /4'
P� WA lER/N PALE BROW RAE SANO .7p
0 20'
is
ing septic
s
)'Siem to be filled in.
mi/lar with the STANDARDS F A`' r
SVD CONSTRUCTION OR APPROVAL �" 2e ����
'SPOSAL SYS OF OR
SEWAGE
SYSTEMS FOR SINGLE F T'rc
=d wi// abide b AMIL Y RESIDENCE
'mit to }' the conditions set forthDan
construct. therein and on e p
th b£sa.'s%L.
SQV,
f(
location
e +2ti jfd
of wells
field and cesspools shown her
observations and
. or from data obtained are
AL7FRA77ON from others. �iin'
OR ADD177ON T Gi y,u, rte, tet•=c�'
iEC770N 7209 OF THE N O Ol/S SURVEY /S
STA A V10LA 170N ;M—Onr
:PT AS PER SEC77ON 7 09 YORK IF EDUCA 77ON
:ON ARE VALID FOR 209-SUBD/V15/ON 2 ALL CER77F7 A77ONS
_ LAW
= MAP OR COPIES BEARI S MAP AND COPIES THEREOF ONLY /F P�
iE SJGNA 77JRE APPEARS HEREON.ESSED SEAL OF 5� �•f-
1NE SURVEYOR
M.ations are referenced
to N.G. V.D.
VONUMENT g� s
EtA=18,732 S c� ��,���
= Q FT, �aDZ ECONIC 8
art C (631) 765-5020� NO.486A
noun1 P.O. BOX 909 A 97
1230 TRA ERS STREET
SOU OLD, N• y 11971
v j