HomeMy WebLinkAboutWilliams -•n
o, ��SFFiji
JUDITH T.TERRY ,/1_� O% Town Hall, 53095 Main Road
TOWN CLERK ; y Z ; P.O.Box 1179
REGISTRAR OF VITAL STATISTICS p '� Southold,New York 11971
MARRIAGE OFFICER =y* O�� FFax(516) 765-1823
RECORDS MANAGEMENT OFFICER : .( * **o."
Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER .000 ,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3633-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner WILLIAMS
Mailing Address 1 C/O ELE DEVELOPMENT CORP.
Mailing Address 2 P. 0. BOX 1143
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1425 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 Li lot 7.035
Cross Street ELIJAH'S LANE
Issue Date: 5/15/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
t
OFFICE OF THE TOWN CLERK 3 3
��
S\FFacr
Town of Southold c ,% C®G Application No.
Judith T. Terry, Town Clerk ,:•
Town Hall, 53095 Main Road =� $10.00 - Residential
P. O. Box 1179 cn •, ; •',;-' Mn ; $25.00 - Non-Residential ,
Southold, New York 11971 OO: $6 *-4t`
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 4111 1 —
•
OWNER NAME: ► ' 1 2 ►�Yl S
OWNER MAILING ADDRESS: 114D-'s C-7 b121 12-
M k , N.•1 ( ( 9
OWNER PROPERTY ADDRESS: .IF21-YY1 C.
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section IOS Block 14 Lot
CROSS STREET: E. l j Ft h Ler e.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New J 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.)
/
"Dnaturi Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
'(,0( v
L� �
et
{
\ e v'
A Q
2 7F
I\ -
266, '
j e
p 1J
s,. SUR.VFY OF
( x Pr -
LOT 11
•
Id`a 1s, "ELIJA1IS LANE ESTATES, SECT. 2
z; -o o b - FLED OCT.$ 1996 FILE NO. 9912
s
°''
AT MA T Tl TUCK
`� f°Pt�• `�� TOWN OF SOUTHOLD
G - SUFFOLK COUNTY, N Y.
,\92CD 0 ;- - _ -fJ 1000- 108- 04 -P/O 7.1
- \ y2 r ,mss Scale: 1"= 40'
Dec. 4, 1996 -
•
26
yy
Z r,a /7 R '2S
i O o� {O� G 3g 2; SUFFOLK gtR4TN A7:I r CE'HEALTH SZRVICr9 •
Sa,
-9 • PHUT PCPs APPIIDV L OPO
NTRUCr7ON v' R A
, �� :mug. PA:.lII.YR'- 'Yo �� DA E FE a•�
c t V APP.OV� _ Yui- sE,8�2' ,e
. ;' I - l MA;GMI3I+�CP�� 3EDRCOMS•
r� h 9�OI�. d u C' WIRES THREE YEARS FROM DATE OF APPROVAL
•
g
1 �� `so 52�` Q - .
1997 • �,� %o' 0 3� 5 `Q� `
sock co,Dept ci KeaSlt SES \ -
a ental Pcateol� -
AREA = 40,059 sgft \ . • - - 9 ''�
ANY ALTE4.41 CN OR ADOITYNI ro WS SURVEY!S A VIOLATION I am.familiar with the STANDARDS FOR APPROVAL The locations of wells and cesspools ';-. ,-2-1---q=1 ^1 :V
OF SECTION 7209 OF rte hE7 YORK STATE MCA nom LA 1, AND CONSTRUCTION OF SUBSURFACE SEWAGE shown ,hereon are from field observation �fyJ Y.S LIG NO. 496!8
ttE N As PV1 SECTION 7209-SLSOMSKINCOF 2 ALL CFRTFI ONLY
F DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and oT from data obtained from others. � "('� .,
NERECN ARE VALD FCR A 17€P AND COP ES rt ECF CNL Y F 5CRI1C ci pV
SAID MAP CR COPES d£AR 17E/MESSED SEAL OF ThE SURVEYOR and will abide by the conditions set forth therein and on the P / P.C. (1
oto.sE SGVATURE APPEARS hE,?EON, permit`to construct. 't/- �� •
ADDITIONALLY TO COAILY 'WTI/SAD LA1 77€ TERM A •.LT&7ED 3Y• 12 • t • ER STREET
441ST 3E USED 3Y ANY AND ALL SURVEYORS UTA/ A COPY 3�A NS ARE REM
OF ANOThER SURVEYOR'S MAP. TERUS SUCK AS 74SPECTM•ANOTO AN ASSL7uED CATUK • SOUTHOLD, N.Y. J1977
9ROUGNT-TO-0A78•ARE NOT M CCiPL1AN� IfTT/ ThE LA". ,
' 96 - 317 11