HomeMy WebLinkAboutTessiny OFF0frG.
JUDITH T.TERRY � � y1 Town Hall, 53095 Main Road
TOWN CLERK _ P.O. Box 1179
�y, Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER `. 4 ��� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER = 491 `�►a®��., Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3616-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner TESSINY, AL
Mailing Address 1 C/O ELE DEVELOPMENT
Mailing Address 2 P. O. BOX 1143
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1275 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 7.036
Cross Street ELIJAH'S LANE
Issue Date: 4/30/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ��S�FFU(,��'-
Town of Southold �Q _� Application No.
alliiir
Judith T. Terry, Town Clerk y
Town Hall, 53095 Main Road . $10.00 - Residential
P. O. Box 1179 to $25.00 - Non-Residential
Southold, New York 11971
Telephone ! ar.
•th if
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 4111 199-
OWNER NAME: P I 2SS'1 ►rl
OWNER MAILING ADDRESS: 1 aI S Qj b Iz i
Imo(
OWNER PROPERTY ADDRESS: S ta-m
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 1 0% Block 14 Lot • 3(40
CROSS STREET: E I 1 j Ab
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New �xisting
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.)
#"
Sign �e of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
F < -
`17 _I
�2� 55 ti — •• SURVEY OF -
`� 0 LOT 12
‘f
Q . �� TE SECT. 2 /L) 0 3
ti.-- � t x� 0 ELUAHS LANE ESTATES, ��
s, S - , p5,,,,, G FILED OCT. 8, 1996 FILE NO. 9912
,,- ' ' /• -P AT MA T TI TUCK
/SQ^ = R = 25.00 ,' TOWN OF SOUTHOLD
` 3927` 31
• SUFFOLK COUNTY, N Y.
1000 - 108 - 04 - P/0 •
7.1
0
• s Scale: 1" = 40'
Dec. 4, 1996
2�A• .
•
SUFFOLK COLMY DEPARTMENT OF HEALTH SERVICES
/ \s APYAL W O,opeTUVCIO
rt PM A
ox FAMILY
--- ,. , « ONLY
.vii RsuFai - i
�v c.,� DATE FEB Or -
APPROVES
P y BOOMS
`�' 'l�OR�s,�uM�'�_
5 T YEARS FROM DATE OF APPROVAL •
QV
•
am familiar with the STANDARDS FOR APPROVAL The locations of wells and cesspools ��
'D CONSTRUCTION{ OF SUBSURFACE SEWAGE shown hereon ore from field observaho s 1 N.Y.S. LIC. N0. 49618.
3POSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and or from data 'obtained from others. �" '��;
I will abide by the conditions set forth therein and on the YC,NIj r:; •'-S, P.C.
:mil to construct. W.:4°10 6 q • :1 =