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ELIZABETH A.NEVILLE ® 4 Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS I Fax (516) 765-1823
MARRIAGE OFFICER • ® ®� 1/ Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER -0„10
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3825-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner FRIEDBERG, F. PAUL
Mailing Address 1 C/O GENDOT ASSOCIATES INC.
Mailing Address 2 P. O. BOX 847
City St Zip WADING RIVER NY 11792-0000
Property Address 1 195 SELAH LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-929-4310
Tax Map No. section 106.00 block 9 lot 4.005
Cross Street COX NECK ROAD
Issue Date: 10/21/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK .0
FO(/'•Z' C
TOWN OF SOUTHOLD
CSG Application No.�o ��
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ELIZABETH A.NEVILLE,TOWN CLERK ' 0'
$10.00 - Residential
P.O.BOX 1179 I
SOUTHOLD,NEW YORK 11971to g1.0; $25.00 - Non-Residential
®!Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /1.3174.
Fee $ �, t
DAT E7/5/9
OWNER NAME: f I' •
OWNER MAILING ADDRESS: � ® •P''' �� �c'g�
f7 a W l&
OWNER PROPERTY ADDRESS: , I / I (Ya--011----7
OWNER TELEPHONE NUMBER: e//2;/ ---A--4.41---"r 9c.79 "-- c43/0
TAX MAP NO. : Section ! /O Block 9 Lot 5
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CROSS STREET: f/ � �
TYPE 'OF. SYSTEM: Septic Tank V New Existing
Cesspool / New Existing
g
Residential 1/ 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.)
AZGI FA;;-`117---Signature of Applic
•
RECEIVED :BY,:'
Town Clerk's Office
DATE:
LOT AREA = 37,304 SQ.FT. 98_ 4 91
CHURCH
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WELL
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CESSPOOL , SEPTIC TANK ,WELL 1 inLOCATIONS BY OTHERS -
• 1/ I
COX NECK ROAD
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9-21 - 1998 FINAL SURVEY I
i ' JOB NO.98-297 FILE NO. WEST MILL
Ht OFFSETS (OR 0IMtNSIONS) GUAKANTEES iNL)u.AItU rbncv.
,HOWN HEREON FROM THE SHALL RUN ONLY TO THE PERSON SURVEYED FOR t
,TRUCTURES TO THE PROPERTY FOR WHOM THE SURVEY IS PRE- ,
INES ARE FOR A SPECIFIC FUR- PARED, AND ON HIS BEHALF TO 1
' 'OSE AND USE AND THEREFORE THE TITLE COMPANY, GOVERNMEN LOT NO. 3
iRE NOT IOFu".JED TOS, GUIDE THE TU AC^C-i'LISTEDSr�SEREON, AND NETT-
REGION LENDING MAP OF WE$T MILL 5UBDlVISION 1
S, OF FtPATIIO RETAINING TTIO�
HALLS, POOLS, PATIOS, PLANTING THE ASSIGNEES OF THE LENDING I
\REAS, ADDITION TO BUILDINGS INSTiTUTIc GUARANTEES ARE SITUATED AT MATTITUCK I
)R ANY OTHER CONSTRUCTION NOT I,ANSSFERABLE TO ADDITIONAL _
INSTITUTIONS OR SUBSEQUENT 1
INAUTHORIZED ALTERATION OR OWNERS TOWN OF SOUTHOLD- SUFFOLK COUNTY N.Y,
DDTTION TO THIS SURVEY IS A
IOLATION OF SECTION 7209 OF COPIES OF THIS SUNY MAP NOT SCALE 1" = 40' DATE 6- 17- 1998
E NEW VO
Al
EDUCATION INKEDN SEAL G EORA SURVEYOR'SND
EMBOSSED SEAL'V _SHAH Nn* BE CONcIDFRFD TO FF FILED MAP NO. 9539 DATE 7-20- 1994
1 G U A R A N T E E D �. O r1 1-0N, TAX MAP NO. 1000-106-9-4.5 (REF. ONLY) DISK 180 ,
o O , HAROLD F. TRANCHON JR. P.C.
Os' e ,t 2
x MII 7' LAND SURVEYOR
pa
1866 WADING RIVER-MANOR RD. WADING RIVER,
<� N 2 O
HI �' °• 045; �,� NEW YORK, 1 1792
I 'fi `r�� �sFD ,^O S .Y. LIC. NO. 048992
516-929-4695
HAROLD F. TRANCE- c .,'._I: PENN LIC. NO. 21115-E