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JUDITH T.TERRY X1/11 tr Town Hall, 53095 Main Road
TOWN CLERK ` P.O. Box 1179
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Southold,New York 11971
REGISTRAR OF VITAL STATISTICS V ® Fax(516) 765-1823
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MARRIAGE OFFICER #41, 1
RECORDS MANAGEMENT OFFICER ®,` **Oil.
'll Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER •• ,�'��
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3630-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MULHALL
Mailing Address 1 C/O ELE DEVELOPMENT CORP.
Mailing Address 2 P. O. BOX 1143
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 970 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 7.026
Cross Street ELIJAH'S LANE
Issue Date: 5/15/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
10-.-# 21
36 3
OFFICE OF THE TOWN CLERK c3IFO�
Town of Southold �s CQG,� Application No.
Judith T. Terry,' Town Clerk
Town Hall, 53095 Main Road -< $10.00 - Residential
P. O. Box 1179 cry • . • i ;' $25.00 - Non-Residential
Southold, New York 11971
Telephone '40 1
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION 'PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 4 ` ri , c
M
OWNER NAME: ti I hC-
OWNER MAILING ADDRESS: b2 I __ ( I a
11/1 �--1-c -�mac• k 1./.' l (9 Z
OWNER PROPERTY ADDRESS: C
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section Block 14 Lot
CROSS STREET: G l 19rh 'S Ler
J
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 'L- New v 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.)
Signa i*e of Applicant
RECEIVED 'BY:
Town Clerk's Office
DATE:
O:CY
C,��.
- COs` "�so �� =_b�Er� ^ ��. SURVEY OF
�a` �65e�g ��-9�. LOT 21
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�`�' "ELIJAHS LANE ESTATES, SECT. 21 111114
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R -21 oD e FL DCT. 8, 1996 FILE NO. 9912
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L -sans 09 ,• s
Zo o`a' g'''' �� ��' A T MA T TI TUCK
/ TOWN OF SOUTHOLD
o �F, SUFFOLK COUNTY, NY
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t." ,\0,'2 \ 1000- 10a- 04 -P/O 71
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\ Scale: 1rr- 40r -
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\ ' ! 3UFFOiO CCOUNTY DO`hrIMENT Or HEALTH=vim
Q e P e{c/ PIvP. ,3�i POI.APPROVAL O8 COl ,UCTTOfi 1
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�'_ 51�16i.£FAA *T.Y BICE OXY A
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'r ,\ Al1.r 4• ` I APPROVED LJErwr � lr'O .. .. �
0 -,, ,`92o FOR MA i M oz ) BEDROOMS `� a 1991
O `°s y2 EXPIRES' REE YEARS FROM DATE OF APPROVAL • E ,�,2�1�ph
i\ 4,, ,,,..,.„„.....,,,„. to
moi,- .�
e 1
AREA = 40,024 sq.ft. \-�• - _
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ANY ALTERATION OR ADO1TKW TO 77l5 SURVEY IS A VIOLA 170N / ern lcri�ior with Me STANDARDS FOR APPROVAL The locations of wells and cesspools - ,iAti,5
OF s£crpN 7209 of THE NEW coax STA TE EDUCAr10N LAW, AND CONSTRUCTION OF SUBSURFACE SEWAGE shown hereon are lron field observa6ans - S. LIC. N0. 49618
EXCEPT AS PER SECTION 720.Si.�CrrVlS10N 2 ALL EOF OhATlO. DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and or from data obtained from others. - �'=' ;.
HEREON ARE VALD FOR R m.VAP Ahs COPIES rr.or n ONLY F.
SAD.VAP OR CCPIES BEAR THE DRESSED SEAL OF THE SURVEYOR and will chide by the conditions sal forth !herein and on Jhe PECONIC SURVEYORS, P.C.
•
WHOSE S1CNATURE APPEARS HEREON. permit to construct. (5561 763 - 3020
` ADDITIONALLY TO COMPLY MTM SAD LAW Elf TERM 'ALTS M Br' r• ` P. O. BOX 909
MUST BE USED BY ANY AHD ALL SURVEYORS U /ZT�G A C Y ELEVA PONS ARE REF.-RENCFc7 _ 1230 TRAVELER STREET
OF ANOTHER SURVEYOR'S fur TERMS sub AS NSPECrED-ANO To AN ASSUMED DATUK SOUTHOLD, N.Y. 11977 ,
BROUGHT-TO-DA rc ARE NOT M COFPLIA CE MTN THE LAX
- 96 - 317 21