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ELIZABETH A.NEV1LLE y®� _ ®may Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
e� 4 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 1I
MARRIAGE OFFICER Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER �4/�f ® 1�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER N..
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3822-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner GALJANIC, NICOLA AND LISA
Mailing Address 1 50-03 28TH AVENUE
Mailing Address 2
City St Zip WOODSIDE NY 11377-0000
Property Address 1 1065 BAY AVENUE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 718-278-0558
Tax Map No. section 31 .00 block 9 lot 1 .000
Cross Street NORTH ROAD
Issue Date: 10/06/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•
-_.'OFFICE OF THE TOWN CLERK �c�\1FF�C, --
Town of Southold &,% %1L-_\ Application No., 3822
Judith T. Terry, Town Clerk ,:At,c ;.y j5. • %34...c1) $10.00 - Residential
Town Hall, 53095 Main Road
P. O. Box 1179 v' -, ;' , T► i' $25.00 - Non-Residential
Southold, New York 11971 O i'f• : - m-$
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
-- for -- -
- ' ' , OPERATION-PERMIT ' __ - _
- SEPTIC TANK or CESSPOOL
Operation Permit No. /63,1 R
Fee $ /0 .00
DATE 9/�Oqg
OWNER NAME: tg�-6.` Jakv •
a c__ j N C '_01 c, LA s A .
OWNER MAILING ADDRESS: SID --03, a AueA (AIa.
G--)r-A 5 4(sh> Aiy 0'77
- - OWNER PROPERTY ADDRESS: /06'c ZA i :.2z vI(It J_ -
OWNER PROPERTY moi, � v►�i.�.
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OWNER TELEPHONE NUMBER: —1i 272 QUA,
TAX MAP NO. : Section 31 Block q Lot
CROSS STREET: ilki/G);--K., iRc,:ac)®
TYPE OF SYSTEM: Septic Tank V New / Existing
Cesspool ew 7 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.) M
gq4 /y
Signature of Applicant
RECEIVED BY: 1)3(2L--•
own Clerk's Office
11 DATE: ` Oa C1-4
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W OJtf�N,� oa
Dept.Of Hea to t vwco
•-S. 0 Office Of Wastewater Mgmt.
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SURVEY OF PROPERTY
SITUATED AT
EAST MARION
• TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-31 -09-01
SCALE 1" =20'
OCTOBER 19, 1995 SURVEY
MARCH 21 , 1996 ADDED B.O.H. DATA •
MAY 22, 1998 FOUNDATION LOCATION
SEPTEMBER 4, 1998 FINAL SURVEY
AREA = 17,589.59 sq. ft.
0.404 ac.
CERTIFIED TO:
NIKOLA GALJANIC
LISA GALJANIC -
NOTE:
• S.C.D.H.S. REFERENCE No. R10-96-0101
Not1. ts
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\A°0,. A ./ __ .
�4. 4. , LS' <<\(<\ �SU1 OT.�G COUNTY DEPART/414'1:0F HI.ALTi SIA VICES
4� i,;AAr�PY OVAL OF CONSTRUCTED WOWS FO
N SINGLE l K.t.4sl.,.'EIT,S1.3E1:CM
H.S.:et:Ho. �6.�...�f
4. iso The sewage d!,ozal and water supply facilities et this locution hr.ve been
'•o 1 specteo andfor certified by this Dein,w . or other agencies and found to •
IP A' be satisfactory FOR r rl . OF 13 ROOMS.
o°o
o�P• 1`1.� Chief
St hen A.Costa,F.E.,
011- N� Office of Water and Wastewater Management
UNATHORIZED ALTERATION OR ADDMON
TO THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF THE NEW YORK STATI
- EDUCATION LAW.
( IY,` '� THE LAND SURVEYOR'S INKED SEAL OR
COPIES OF THIS SURVEY MAP NOT BEAR
It1 G ‘,W- E)ABOSSED SEAL SHALL NOT BE CONSIDI
T' TO BE A VALID TRUE COPY.
G 0 5 $ G y GUARANTEES
TO � WHOMN SHALL
I
S V IS PREPARED. AND ON HIS BEHALF TO '
mix COMPANY. GOVERNMENTAL AGENCY
-. LENDING INSTITUTION LISTED HEREON. Al
TO THE ASSIGNEES OF THE LENDING IN!
TUTION. GUARANTEES ARE NOT TRNSFEI
F
m
N ND/OR�EASEMENTS OFA EDCORD,AI
a cr.) NY, NOT SHOWN ARE NOT GUARA
O O rn c
N m m. PREPARED IN ACCORDANCE WITH THE MINIMUM
_~END o BY THE LI FOR TITLE sum AS ESTABLISHED Joseph A. Ingegr
�t C a BY THE USE AND APPROVED S ADOPTED
la N W Lp FORTSUCHISE BY THE NEW YORK STATE LAND
TION.
Land Surveyor
3N
JC1 °6e3?,
4 ..�e Title Surveys — Subdivisions — Site Plans — Con iructio
r�
e Y*�,-.1 PHONE (516)727-2090 Fax,(516)72
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= OMCES LOCATED AT M/bUNG AL
�Va6:4:; _,a, . . No. 49668 One Union Square P.O. Box
spy i OP' Aquebogue, New York 11931 Riverhead, New