HomeMy WebLinkAboutSuspenski, Stephen I 1
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ELIZABETH A.NEVILLE �'� ,`O �o \ Town Hall, 53095 Main Road
TOWN CLERK i P.O. Box 1179
cn a� Southold,New York 11971
REGISTRAR.OF VITAL STATISTICS G Q
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER N. Telephone(631) 765-1800
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FREEDOM OF INFORMATION OFFICER ': , ;i southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4303-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner SUSPENSKI, STEPHEN
Mailing Address 1 34 DRAKE LANE
Mailing Address 2
City St Zip LEVITOWN NY 11756-0000
Property Address 1 1205 EDWARDS LANE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-731-3068
Tax Map No. section 18.00 block 3 lot 19.000
Cross Street COUNTY ROAD 48
Issue Date: 1/25/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE i'� �dTown Hall, 53095 Main Road
TOWN CLERK Ca ft ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS VO V I Southold, New York 11971
MARRIAGE OFFICER . 9# a0.,f' Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER 1 * I,oi, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER -------,,...0° southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 X or Non-Residential @$25 Application No-'1303
Permit No. 3i32.8
Owner Name S'k per\ CDerr k.i
Owner Mailing Address S u r o. e LcA.n e
Ln I i- rl N Y 11-75 (.0
Owner Property Address 12 )5 Cc!v%tO..rcib L.ccne,
C'')(--, e v,4- 1.Y-r) t1GJ 7
Owner Telephone No. 5 I (p — 1 31 1 3008
Tax Map No: Section 1 S Block Lot ) 9
Cross Street C. R. Lik E EckAXArrl U e
Please check each that applies: New Construction
Alteration to Exist g 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.)
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HEAL 1H DEPARTMENT REFERENCE NUMBER R10-05-0067
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`b�. SURVEY OF PROPERTY
!' �. AT ORIENT .
- TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
S �1 �ti, 1000-18-03-19
yo iikv 0o,�' SCALE: 1'=50'
oi ,o. �Q°'� �" ��� ,� MARCH 18, 2005
To AUGUST 18, 2005 (foundation location) _
\o O� NOVEMBER 21, 2005 (Final) '
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ANY ALTERAlTON OR ADDITION TO THIS SURVEY IS A VIOLATION 'ECONIC S _AO^ �., 8 '
THE L OCA T70NS OF WELLS & CESSPOOLS / OF SECTION 72O9OF THE NEW YORK STATE EDUCATION LAW. `.;.
SHOWN HEREON ARE FROM FIELD y EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIRCAT7ONS (631) 765-5020 s ., S'fi. _ 1797
‘01-5 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P.O. BOX 909
OBSERVATIONS AND OR DATA OBTAINED 4' .-� \ SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET
FROM OTHERS. WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD,HOLD, N. Y. 11971 03_X21ry
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