HomeMy WebLinkAboutDavis, Janet (2) A`pF S0045,-
ELIZABETH A. NEVILLE /I'�� O4 Town Hall, 53095 Main Road
TOWN CLERK * P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ,i Southold, New York 11971
��
MARRIAGE OFFICER �` �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICERg'C �^a
Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER COUNT ,,",'' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4342-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner JANET A. DAVIS
Mailing Address 1 PO BOX 1604
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 45395 MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-2379
Tax Map No. section 75.00 block 2 lot 1.100
Cross Street PRIVATE ROAD,MAPLE AVENUE
Issue Date: 6/29/07 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
,I %g�FFOL,�coG
ELIZABETH A.NEVILLE ',i 4 y Town Hall, 53095 Main Road
TOWN CLERK i4 I P.O. Box 1179
Z ; Southold, New York 11971
REGISTRAR OF VITAL STATISTICS g Al
MARRIAGE OFFICER ' 1� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER y�� aii�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER '- '� ••• 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. '13 L10�
Permit No. 3 S �f 1
Owner Name J o, e t) . 174 S
Owner Mailing Address P. U Cox 14 o y
So, -1^ d N. y // 9 7/
Owner Property Address /S .3 atz
L �
Owner Telephone No. 7 6 `� • ,2 3 7 9
ll.
Tax Map No: Section 7 S. 00 Block 2 Lot - —
Cross Street P v d e e c)L.`o I e.. e e
Please check each that applies: New Construction
Alteration to Existing System ?X
Residential )C 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.)
'G //8/ o
Sigfaure of Applicant Date
Received by:
—
o /o`AOF sou ,o
ELIZABETH A. NEVILLE 1...% l0
Town Hall, 53095 Main Road
TOWN CLERK ir * P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ; G Q i Southold, New York 11971
MARRIAGE OFFICER . 3 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER lCOUR 1'M,+ 11i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ` -� � , southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3549 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JANET A DAVIS
Address 1: PO BOX 1604
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
REPLACE EXISTING OLD BRICK CESSPOOL.
MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS,BUILDINGS,PROPERTY LINE
S AND WATER BODIES.EXCAVATION INSPECTION REQUIRED.
Name Of Owner SAME AS ABOVE
Mailing Address 1
City St Zip 0000
Property Address 1 45395 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 75.00 block 2 lot 1.100
Cross Street MAPLE LANE
Building Permit Number Cross Reference:
clArdawanmmill
Issue Date: 6/12/07 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
1
- - -___--- - t S 1. +r`l. !rte • �\ '• t.-- :,.../•~*' �/! i
i Y1�
I
...-.---
f
i
1 • i
1
C.j ~J Jv E. .--r- .�f Ji1L J�.�Yr?� hi•�f•
0 -
_: _l I -
IZ
L)
•
d
RVArJ cess / `
I
r
11 " l J
if
I
Ip,r.------____ I
� EArc�� � �' -'• �
1
1~ E 1e�
ii �
•
I ,,. 1'� i
77-1,
i l
i � •
I5 I J t =To 2`! ' t j
...-
SI \ ��? •
tIto I • ;j h r- 1
ui J 1 u ? Ea: ,,, ��: • i L f v� j
4
/-
rte 1:":;0..
r r)'-'3-''
`y\f r,- ...
.. IFS F - 'A : MA=-, t:a1J'G75-� t I.
PT+rtuTnond1�•wuctcwrron ow ADDrtloe ..
- - - tO TY A+`YEY IS A YICLAT1ON O --.. ----^_.� ,---7. -1:-"------1
--
EL?i0~72C4 OF THE NEW YORK STATE
-
Ci�isES CF::,C'J)Y!. NAP NOT PE-AraNG
-
«_ YHAOiF TTHE SURVEY
,..: .m„ ,.-'.az :may,,;: t';'''';'''''''1;72::'---;---'-'/"'.7-''-'''L''''":;_:-.--- _ F3�- . _ _ .-: , , . ,
.M. .. ., . � _ . . .� .�'iTJTJNUSTED J;
_ _ _ a _ __ . , _,. .. �-_, __,� ..-- >�. _
_. _ ' .,.,. .-... ., _y... _,. _
.., z r _. ueES
.. .,. ‘.--','-'-''',k-',;!;-::1-±7...7-17'- •.„
�- . .. -.. _. _-.,.._._ _.. O s ASSr U3'NrfVG sr,'h��
�,. ,.. .ti. _. .•.. ...--. _- _.. .:. • -.- ._ __. • .. ,_. : . _... . ..: . . . -.. ..:-, .,..�:- !'' GU NOT TWEFE�
O ADDft1d+
-_ _ .-. --:.:,.-._�. .may
_ . . - #tODERICK VAN TUYt..P.0
.tff
_.. , � `i__ �,4 ,:4„,.1..,,-,-,- it.;
. . - � '`�-.::.•,. .,_y �, Rex _ I
:'''''LICENSED LAND SURVEYORS _.:
fREENPORT NEW YORK
YEUDYNT POSY N7:2= -