HomeMy WebLinkAboutHorton, Debra A ���� u•
ELIZABETH A. NEVILLE e 1• 4
Town Hall, 53095 Main Road
TOWN CLERK 1 * P.O. Box 1179
REGISTRAR OF VITAL STATISTICS G
Southold, New York 11971
MARRIAGE OFFICER /` . •� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER : lN. d�' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ' C�U +� , southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4350-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner DEBRA HORTON
Mailing Address 1 970 RTE. 25A
Mailing Address 2
City St Zip MILLER PLACE NY 11764-0000
Property Address 1 3555 DUCK POND RD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 631-744-5000
Tax Map No. section 83.00 block 1 lot 1.300
Cross Street DEPOT LANE
Issue Date: 8/08/07 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ��� Town Hall, 53095 Main Road
TOWN CLERK t h Z ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS V O .�/�� Southold, New York 11971
MARRIAGE OFFICER y Q� ��� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER _.01 * $,,i' 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. ✓ 5
Permit No. J 3
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Owner Name 1S(c ht 0L-1-0A)
Owner Mailing Address q�? 0 e4- 01 S A
LL e - 4-cG t c164
Owner Property Address 3 S& p itG C dc. CA)
C u k ''GCS= kk{ 1/ gas
Owner Telephone No. C3i – -7441 — c000
Tax Map No: Section i o0 6 Block S Lot O 1 /
Cross Street p6Qa4- Lrrn'
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.)
- )0 -1
Signature of Applicant Date
Received by: (YIC✓l+OC
LOT NUMBERS REFER TO "MAP OF VIS TA BLUFF" FILED
IN THE SUFFOLK COUNTY CLERK'S OFFICE ON MARCH
N 15, 1968 AS FILE NO. 5060. .
SCDHS Ref.# RIO-04-0084 SURVEY OF PROPERTY
' , AT CUTCHOGUE
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
1000-83-01-13
SCALE 1'=30'
JANUARY 13, 2004
MAY 11, 2004 (B.O.H.)
NOVEMBER 22. 2004 (RENS/ONS)
JANUARY 12, 2005 (REVISIONS)
AUGUST 16, 2005 (REVISIONS)
JANUARY 6, 2006 (FOUNDA770N LOCATION)
OCTOBER 11, 2006 (FINAL)
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AREA=20,789 SQ. FT.
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A=STAKE 1n--i - e "(WIC IC. N . 49618
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION ' ECONIC ' ' I + i%... =- �„
OF SECTION 72090F THE NEW YORK STATE EDUCATION LAW (631) 765 a. A 4i;•c C3 87 5-1797
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS P.a BOX 91 ' S
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRA VELE'
WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N.Y. 11971 03-304