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HomeMy WebLinkAboutPark C®� ELIZABETH A.NEVILLE ���`�` .� Town Hall, 53095 Main Road �y TOWN CLERK ® % P.O. Box 1179 y 2 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ;0 $ Fax (516) 765-1823 MARRIAGE OFFICER �‘ #4. # ®�'�� Telephone(516) 765-1800 RECORDS MANAGEMENT OFFICER _�®� a � FREEDOM OF INFORMATION OFFICER i� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3805-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner PARK, WILLIAM AND TERRI Mailing Address 1 P. O. BOX 1089 Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 4225 BRIDGE LANE Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-6372 Tax Map No. section 84.00 block 4 lot 11 .003 Cross Street RT. 25 AND RT. 48 Issue Date: 7/31/98 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK3 3 Town of Southold c., eCQ ' Application No. o� Judith T. Terry, Town Clerk ���sP" � �er .0 7 $10.00 - Residential Town Hall, 53095 Main Road 8 3 P. O. Box 1179 v' 9 '41 `' �' $25.00 - Non-Residential Southold, New York 11971 O ® e'`'; $ Telephone (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. u� Fee $ \ 0 , C C) DATE \-- --q OWNER NAME: aD1 \\\ncy) Poc \< OWNER MAILING ADDRESS: PD P)0)( ( D •(vLk \\Q 35 OWNER PROPERTY ADDRESS: Q0.5 or dq,er— c u4cbo ()� \qa5 OWNER TELEPHONE NUMBER: '1 ;2..4 ., L�3� TAX MAP NO. : SectionBlock H Lot ' ` , CROSS STREET: . L V TYPE OF SYSTEM: Septic Tank X New x 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 7iplicant RECEIVED BY: Town Clerk's Office DATE: t `I ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION / am familiar with the STANDARDS FOR APPROVAL • P OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, AND CONSTRUCTION OF SUBSURFACE SEWAGE EXCEPT AS PER SECTION 72HIS MAP AND ALL CERTIFICATIONS ONLY/IFONS ;; W�iI DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES HEREON ARE VALID FOR BEAR T E M AND COPIES THEREOF E and will abide by the conditions sel forth therein and on the SAID MAP OR COPIES THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. <91 1 permit to construct. Si ADDITIONALLY TO COMPLY WITH SAND LAW THE TERM ALTERED BY' 4- MUST BE USED BY ANY AND ALL SURVEYORS UTILIZING A COPY �,0 n c•• � 4 well OF ANOTHER SURVEYOR'S MAP. TERMS SUCH AS %N 2 -SPECTED-AND / .jc3 Q O a. BROUGHT-TO-DATF ARE NOT IN COMPLIANCE WITH THE LAW. 361, cz �o �� 4,„,,i1 The locations .of wells and cesspools G�>>^`� /,`C \ shown hereon'*e from field observations �,,� c and or from data obtained from others. \ Lot 01 , 1, kt • SCDHS REF NO. = RiO - 97- 0088 / \ / �� S T. / L`�� '� C.P v'•"F;FT 9 ,ems ` , j O ' �}0 / © m. 21 o. oo C ` / ° � / SEPTIC Z .A, / 'h0 \�SYS7EM `Q+ cn�ti 7 Op�oo /55, 49 WELL . o cs , plo cp 1010010P• , l°Pe ' ' I ' ?� �y e��e Q, 635 • �3 3 \ A-°--,--cN Nt)161.9 . , \ , ,i 00 0 SURVEY OF %. '; � OP LOT 3 �-9 FROM MINOR SUBDIVISION MAP `� -' 1• OF ,:- 0 P " SHALVEYPROPERTIES " 0 FILED JULY 16, 1990 FILE NO. 8975 - v. `� A T CUTCHOG(JE re, g.0 TOWN OF SOUTHOLD - OF NEW SUFFOLK COUNTY, N Y. �.\, 1. MFT ), .1000 - 84 - 04 - 11.3 �' >o��. 4M_Z�F� O CERTIFIED TO' SCALE: 1"= 50' • `. .'` WILLIAM W. PARK MARCH 27 1995 NJ .II ' , =,>r5 * ,1. TERRI L. PARK ,i �,`; '`��N.Y. C. Na 496/8 LAKE SHORE ABSTRACT, INC. April l6 /997 (SCDHS INFO) __��.. SUFFOLK COUNTY NATIONAL BANK Oct. /0,1997 (foundation) PEC'"�•., I RV OSS �� ' (516) : _ +2E7 6, May /3, l 998 ( final ) P. 0. B. i D sv t '= MAIN ROA CONTOUR LINES ARE REFERENCED TO AREA = 20382 ACRES , THE FIVE EASTERN TOWNS TOPOGRAPHIC, MAPS SOUTHOLD, N Y. 1197/ ,r R �- - , 9a,- 141