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JUDITH T.TERRY ,� y 7°-.A Town Hall, 53095 Main Road
nt
TOWN CLERK 3 P.O. Box 1179
�� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ® �� zF_ ,;
MARRIAGE OFFICER : e `' ''' •1 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER = 14 tip° Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ,,.�1�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3619-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MCLEAN, DEREK
Mailing Address 1 C/O ELE DEVELOPMENT CORP.
-
Mailing Address 2 P. O. BOX 1143
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 515 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 7.041
Cross Street ELIJAH'S LANE
Issue Date: 4/30/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
1-1
OFFICE OF THE TOWN CLERK ��FFnt,� '-
Town of Southold �p CSG Application No.
Judith T. Terry, Town Clerk .`� J►`
Town Hall, 53095 Main Road � , ,� �_.
.. $10.00 - Residential
P. O. Box 1179 Ns �;' $25.00 - Non-Residential
Southold, New York 11971 %O • "
Telephone 40;.:
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 1-4 11 ' g
OWNER NAME: 2_42 k M C L £-
OWNER MAILING ADDRESS: 615 C-) z o 12i a I I c. +.
1\-- 1 Z4-'F'i -F t.t k I 1•/. / 119 2-
OWNER PROPERTY ADDRESS: 5-n-Yl L,
OWNER TELEPHONE NUMBER: 4 I
TAX MAP NO. : Section ( O% Block Lot .41
CROSS STREET: 2_I i I Y h 'S LA1 C._.
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.)
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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2�ko� SURVEY OF
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O°' C Q v e'' "ELIJAHS LANE ESTATES, SECT. 2
�'? /QT FLED OCT.$ 1996 FLENO.9912 .
/422/• - AT MATTITUCIG�= TOWNOFSOUTI-�OLD<O / tvP :9'17
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SUFFOLK COUNT Y, -N. Y.
Z �� `� woo- 108- 04-P/O Z1 .
>� n' `• ? ��,x`''' Scale: 1"= 40'
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Q WIRES THREE YEARS FROM DATE OFApEgRO
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S�� I-0�� 5 �N T-Mer �
,o0 �, AREA = 43,646sq.ft
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ANY ALTe'r Arfav oR ACClT1GW ro TTiS SURVEY S A MLA MN l ern /cmi/iar NO the STANDARDS FCR APPROVAL The locations of we/Is and cesspools . / 4 •
cf SECr_pr ACs 7209 CF 77-E P CT 1C4iR STA
Z�u e7704 r}�xrri7xNs AND CCNSir?UCiCCN OF SUBSURFACE SEWAGE shown hereon are from lleld observation ' `,, �r��:�:.�"1� UC NO. 49618
•'S ECN ARE VALD FCR 77-1E- MAP APO WIPES ]hEr?_CF QhtY F DISPOSAL SYSTEMS FOR SINGLE FArMILY RE ICENCES and or from data calcined from'others. �L�t>i � v
SAID MAP CR CCPES OE.R 7741E iAPRES,SED SEAL CF DE 31...7fVEYCR and -.nil cbide by the conditions set forth therein and on the - PECONhc. Pl e,0”- P.C.
411105E a'TCNA TLRE APPEARS PF1tEC44.' permit to construct. - tem 765 - 5020
ACCITTONALLY To CCAI LY 741771 SAO UV 771E TeffI AL reArrn 31- P. 0. BOX 909
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TRauottr-ro-aAra ARE Nor 14 CCirL:ANCE 4,171NELAW. ro AN AS;sLUEa 0.4 ITU SOVJTfd0L0, N.Y. !1971
96 - 317 17