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JUDITH T. TERRY A' Town Hall, 53095 Main Road
TOWN CLERK 111P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER *4,' Fax (516) 765-1823
eAn ,i! Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 859 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SUN ARK HOMES INC.
Address 1 : P. O. BOX 142
City St Zip WESTHAMPTON NY 11977
Descripton of Proposed Construction or Alteration
NEW SINGEL FAMILY DWELLING WITH SANITARY SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 10/22/91 .
Name Of Owner STANEVICH, ROBERT
Mailing Address 1 75 CEDAR DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 705 TUTH I LL ROAD EXT.
City St Zip SOUTHOLD NY 11971
Tax Map No. section 55.00 block 6 lot 15.009
Cross Street YENNECOTT DRIVE
Building Permit Number Cross Reference:
Issue Date: 7/08/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE QF THE TOWN CLERK
Town of Southold
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Judith T. Terry, Town Clerk �� . 4 , Application No.
Town Hall, 53095 Main Road o its,- k114•:, Construction c�
P. O. Box 1179 ��� 'Southold, New York 11971 � � Alteration
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Telephone 10-1 Residential
(516) 765-1801 „� Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 0Y/2--
APPLICANT
NAME:
APPLICANT ADDRESS: )0o X30/ /y•Z / 57-721 /2i ,,
SEPTIC CESSPOOLy
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION /UFS
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /2O 6 p? ( 7/9/tiff. I f
OWNER MAILING ADDRESS: '73— L/h/fjZ bg
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OWNER PROPERTY ADDRESS: 705
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TELEPHONE NUMBER OF CONTACT PERSON: cc- 6 '5d
TAX MAP NO. : Section S � Block 6 Lot /,� , c.)7
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CROSS STREET: y/Z/U/c-vcf��j , U1`?
BUILDING PERMIT NUMBER CROSS REFERENCE:.
avy
Sig ure of Applicant
RECEIVED BY: 11 , Lt�
,' ow Clerk's Office
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SURVEY FOR
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-- - ROBERT J. STANEVICH & BARBARA J. STANEVICH
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICE: LOT NO. 16, "HIGH POINT MEADOWS, SECTION TWO"
AT SOUTHOLD DATE APR. 21,1992
nFOR APPROVAL OF CONSTRUCTION ONLY TOWN OF SOUTHOLD • SCALE I" = 40'
oATEv�T 2 SUFFOLK COUNTY, NEW YORK NO 92- 0327 ' —
REF. NO._J — , N u*AUTHONIZED ALTERATION OR ADDITION TO THIS
/ J SURVEY A VIEL EDUC I SECTION 7209 OF THE
\\\/`_�����{{{"`•••"1fffLLL---___/// SU'/ YORKYASTATEVII ATIOH Of
LA•
RP�ROVED /
4:.:„......,4 COPIES OF THIS SunvEY NOT BEARING THE LAND tE OF Nfw
7� SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL
/ MPT BE CONSIDERED TO BE A VALID TRUE COPY S �O
THE PERSON row INDICATED
E SURVSMALL PREPARED D TO CPPD W. •
HEALTH DEPARTMENT-DATA FOR APPROVAL TO ONSTRUCT f0 r
AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- y 4. 41.0f".
5 � ('
R WATER GAIN_MI • II SOURCE OF WATER HATE_PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED Y 1 Z
R BUFF CO TAX MAP DIST 1000 SECTION r53_BLOCK- • LOT 1509 NEREDM,AND TO THE ASSIGNEES OF THE LENDING `[i 0
*MERE AR[ NO DWELLINGS WITHIN 100 FEET OF TINS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE 1 tiL
TO ADOITIONAL INSTITUTIONS OR SUBSEQUENT
OTHER THAN THOSE SHOWN HEREON - OWNERS
, '
•THE WATER SUPPLY AMD SEWAGE DISPOSAL SYSTEM FOR THIS RCSIDENC[ N DISTANCES SHOWN HEREON FROM PROPERTY LINES
WILL CONFORM TO THE STAN ONPROf OF THE SUFFOLK COUNTY TO(MISTING STRUCTURES ARE FOR •A SPECIFIC .I� ( A.
OF WEALTH SENIC(S PURPOSE ANO ARE NOT TO BE USED TO ESTABLISH SY -'
APPLICANT. PROPERTY LINES OR FOR THE ERECTION OF FENCES f..T 11' a
0/5,ti2% ,VAlAi ii(Cd• \SND SUR'(E+0
AC°170..ely/412 LdiI47///,.,/) ..., //9.??
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"265 400 OSTRANDER AVENUE
YOUNG a YOUNG RIVERFEAD,NEW YORK
NOTE• ■ V MONUMENT Ao STAKE
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SUBDIVISION MAP FI LED IN THE OFFICE OF THE CLERK OF wx,:
SUFFOIX COUNTY ON MARCH 19,1990 AS FILE NO 8911. .. ALDEN W YOUNG,PROFESSIONAL ENGINEER
AND LAND SURVEYOR N TS LICENSE NO 12845
HOWARD W YOUNG, LAND SURVEYOR
., I TWE LOCATE,'OF WELLWI,SLPTIC TANK(Bn•CESSPOOLS(CPI SHOWN HEREON N Y S LICENSE NO 45893
AM FROM FIELD ORRIERWLTIOMR AMO OR DATA OR TAIUCD FROM OTHERS