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HomeMy WebLinkAboutMalone el oafFO/dr JUDITH T.TERRYI��=1�® 7;4 Town Hall, 53095 Main Road TOWN CLERK ; Z P.O. Box 1179 es• rry Southold,New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER � . •g Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER =�®.( p �e�®611 Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER .� ,.�el OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3621-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner MALONE 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 2210 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 7.048 Cross Street ELIJAH'S LANE Issue Date: 14/30/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) Loo 2 324 • tFFICE OF THE TOWN CLERK Town of Southold � CQG:, Application No. Mr Judith T. Terry, Town Clerk y Town Hall, 53095 Main Road -� $10.00 - Residential / P. O. Box 1179 u' ;' $25.00 - Non-Residential Southold, New York 11971 O ' ���'`, 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 OWNER NAME: 1\-A -a..] dh OWNER MAILING ADDRESS: '7-2-I O al �bVZ, I Q C_,+ M a+--ac-F- 1'4 I IJ•`( I let SZ OWNER PROPERTY ADDRESS: tH'm OWNER TELEPHONE NUMBER: TAX MAP NO. : Section I OS Block 4 Lot 1 • CROSS STREET: alt ft- 1'1 ' Ft-,e 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.) natur- . ' Applicant RECEIVED BY: Town Clerk's Office DATE: 1 0. air --"-' 70 r — --r 0 , cf, ItVeS•4-5) 7 (6r) ; • r 0 is, - ..., , ... . ,, t.....c. • ....`�� SURVEY OF • LOT 2 _ �p _ e �+e1, Z. �� "ELIJAAS LANE ESTATES, SECT. . / E. � cis FLED OCT 8, 1996 FILE NO. 99 5 g2° AT MA T TI TUCK �. 2, '' O Q,.Y- TOWN OF SOUTHOL D �\ , ., \ z 3 S . 25 SUFFOLK COUNTY, N. Y. ���. 62. 1000 — 108- 04 —P/07.1 I �� 2 Scale: 1" - 40' I Jy' Dec. 4, 1996 i AMME �3 — •Z.�+" is / ..L r. i AP C. `,/ MEM �>. Ili `cic ago' • • `ri.� \920 ----EARS FRC •� 552 --- x= O to am 0P . oF kf O 'cTa ���uN S.Mf7 1• AREA Z. rC. 40264 s�q.ft. '( - ''�' �O• d90�2 ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION / am familiar with /he STANDARDS FOR APPROVAL The locations of wells and cesspools .. OF SECTION 7209 OF THE NEVI YORK STATE EDUCATION LAN, - AND CONSTRUCTION OF SUBSURFACE SEWAGE shown hereon are from field observo/ions EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTFICA17ON5 HEREON ARE VALID FOR T7•d 9-SL AND COPIES THEREOF ONLY IF DISPOSAL SYSTEMS FOR SINGLE FAMILY RES/DEVICES and or from deo abloined from others. !�. SAID MAP OR COPIES BEAR THE&PRESSED SEAL OF THE SURVEYOR and will abide by the conditions set forth /herein and on the M WHOSE SIGNATURE APPEARS HEREON. permit to conslrucl. PECONIC 76S EYN ORS, al ADDITIONALLY TO COMPLY $77}7 SAC LAW THE TERM ALTERED Br (5/61 BO - 5020 909 MIST BE USED BY ANY A/C ALL SURVEYORS UTILIZING A COPY P. O. BOX VEL OF ANOTHER SURVEYOR'S MNP. TERMS SUZY AS •WSPECTED'ANO ELEVATIONS ARE REFERQVCED /230 TRAVELER ST. 'BROUGHT-TO-DATE'ARE NOT PI COMPLIANCE WITH THE LAW. TO'AN ASSUMED DA nim SOUTHOLD, N.Y. /I,