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HomeMy WebLinkAboutLepre J j ® I.,,�®OFFOUr JUDITH T.TERRY ; � *� Town Hall, 53095 Main Road TOWN CLERK a ; P.O. Box 1179 n' Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ® ®�� �� Fax(516) 765-1823 � MARRIAGE OFFICER ` �� RECORDS MANAGEMENT OFFICER _ 01 411 �� ,, Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER - ���� .•01 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3628-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner LEPRE Mailing Address 1 C/O ELE DEVELOPMENT Mailing Address 2 P. O. BOX 1143 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 520 GABRIELLA COURT Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 000-000-0000 Tax Map No. section 108.00 block 4 lot 7.023 Cross Street ELIJAH'S LANE Issue Date: 5/15/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) (36 OFFIG?E OF THE TOWN CLERK clvFFU( rIr �'- Town of Southold &,% CQG Application No. Judith T.. Terry, Town Clerk Town Hall, 53095 Main Road $10.00 - Residential P. O. Box 1179 tri ;' $25.00 - Non-Residential Southold, New York 11971 O " 0 �'`, Telephone e( �� • (516) 765-1801 • TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE 4 I n c - • OWNER NAME: L E Pre- OWNER MAILING ADDRESS: J�-© -a-bC2.-1 NI•\I ( ( tet 52 OWNER PROPERTY ADDRESS: Iczicrl(1 G OWNER TELEPHONE NUMBER: TAX MAP NO. : Section 1 OciS Block 14 Lot Z ' CROSS STREET: 1 .11=1V1 TYPE OF SYSTEM: Septic Tank New Existing Cesspool ✓ New Existing Residential Non-Residential LOCATION MAP: Must be attached hereto before permit may be issued. (Locate building and system; give north arrow and feet of distance, approximately, to building and closest road.) /f.,44" ignat , of Applicant RECEIVED BY: Town Clerk's Office DATE: LU4Y g-el 16 • 'SC,IC oT:oo ^ i 0 cr % � A. it moo, '�' " 1.0.5 64 Z Li.' Lark `oma SCP Y,�, • SURVEY OF:� j �' �' LOT :19 . 0 "EL1JAHS LANE ESTATES, SECT. 2 Cscl c z FLED OCT.8, 1996 FLE NO.9912 , - a `�, AT MA T TI TUCK 02° ,5� --- �e TOWN OF SOUTHOLD �� ��� SUFFOLK COUNTY, N.-Y. tl- 1000- 108- 04—P/07.1 h 0 Scale: 1"= 40' ' 0 \ , „ ) s -*--E\ Dec. 4, 1996 —7 ,t,' C\: 7,4/;//: . c' - 6 0 1)1/4 4 G \0. p t- Q...) . 4 ,\' � °��Aira�=�^,mss LL CT 0316TrjC11°1 7-311 A "57 lip /F, DATEF.5 41 ESR • SOD ' L 198.40 O�gORMA Cr I ' Q vailtEs.i ,(EARs FROM DATE OF NPR ROYAI 0 r "I gyp` i r� 0 +ray+ 51�� rG�i � - f4 �: AREA = 40,033 sq.ft. ', ANY ALTMuT1oN OR ADDITION TO THS$JRVEY IS VIOLATION % /c.-ilrcr with, the STANDARDS FOR APPROVAL The locations of wells and cesspools 40 OF SECTION 7209 OF THE hE7 rCRK STATE EDUCA,rCN LAW, AND CONSTRUCTION OF SUBSURFACE SE�dGE shown hereon are from field observationsi , . L. 19 ° N0. 490/8 EXCEPT AS PER SECTION T209-SLBCYNSON 2 ALL CERTFKATlCNS DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and or from dale obtained from others. 41.... / • HEREON ARE VALID FOR-TITSALLP AW COPIES THEREOF OILY E y SAID SLAP OR COPES BEAR THE&PRESSED SEAL OF THE SURVEYOR cod will C'_ide by the conditions set forth !here%n and on the PECONI; SUR'... _ .., .0 - *HOSE SIGNATURE APPEARS IER£OK permit to ccnslrucl. (5(61 765 - 5020 ADOIT/ONALLY TO COA!"LY MYTH SAD LAW THE TERN 'ALTERED Br' P. O. BOX 909 MUST BE USED BY ANY Aho ALL SU4VEYORS u /zwG A COPY ELEVATIONS ARE REFERENCED 1230 TRAVELER STREET OF ANOTHER SURVEYOR'S KAP. TERMS SUCO AS INSPECTED'Aho To AN ASSUMED DATUM. SOUTNOLD, ICY. 11971 'BROUGHT-TO-DAra ARE NOT X COM°LIAhCE WITH THE LAM. • 96 -317 18 -