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ELIZABETH A.NEVILLE • �® Town Hall, 53095 Main Road
TOWN CLERK `� - P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ; �'I Fax(516) 765-1823
MARRIAGE OFFICER ``44, a r ''�1 Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER aa'
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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. 3839-R Residential X Non-Residential
Fee $ 10.00, New Existing X
Name Of Owner ZERVOS, CONSTANTINOS & HEDWIG
Mailing Address 1 P.O. BOX 382
Mailing Address 2
City St Zip ORIENT NY 11939-0000
Property Address 1 15925 MAIN ROAD
Property Address 2
City St Zip EAST MARION NY 11939-0000 •
Owner Telephone No. 516-477-3588
Tax Map No. section 23.00 block 1 lot 11 .000
Cross Street PRIVATE ROAD #8
Issue Date: 12/21/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cOFO1 j
TOWN OF SOUTHOLD 0� COG Application
, ELIZABETH A.NEVI'J.F;TOWN CLERK $10.00 - Residential t b , 03
P.O.BOX 1179
LA SOUTHOLD,NEW YORK 11971 *.$ $25.00 - Non-Residential
• -- Telephone _0.( 0i'
(516) 765-1801 - •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1cE? Sc
Fee $ O ®�
DATE (0- 1 (12(
OWNER NAME: Co STA- Y 1 002 4-1 -EtVUI6 die.VOS.
OWNER MAILING ADDRESS: spa 0 , 60X, ,MS4r
DtEIOT) M tY ! 1,9..5 '7
- OWNER 'PROPERTY ADDRESS:- k 59 D5 '1,01A)
-cL►.on
liekt
East ' t*Jr ti0 htct
OWNER TELEPHONE NUMBER: 5t 6 LET) - 3 Sae
TAX MAP NO. : Section 93 .0 d Block Lot t l ,oo 3
CROSS STREET: ��a j "n2g, �! 0-8
TYPE OF SYSTEM: Septic Tank 4,/ - - - New 'Y 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.)
Sign ture of Applicant
RECEIVED BY:
✓� Town Clerk's Office - -
DATE:
I buy°y' /
�. r Of a� t25' <
O�( A a y°�O� r EP!`o `\ MAP OF PROPER T Y
o ` \25 , \5. E\ EAST AMT
ARION
\ TOWN OF SOUTHOLD
el o SUFFOLK COUNTY,NY.
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Im 1000 - 23 - 01 - 11.3
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MAY 11, 1998
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CERTIFIED TO, �\ \cr° 90\
CONSTHEDW GANTINOS ZERVOSZERVOS t��\ \ `225 �•
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FIDELITY NATIONAL TITLE INSURANCE \f\ /
COMPANY OF NEW Y•:. _` �
SUFFOLK.c YD�AR'maOFHE ansElVIcES 5 �Ogo 0A�`_ F\�� 101
AMOVALOMONSt'RDCTED ivO:.X3 FOR SS PP f
te
0 PAd1u.V SESID> fp ��
76e avow d vistas Ripply ptcilit�es°s Olt:lowliest ' %AK-
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6cs�sf�isryFOR IVa � a o l+�- /
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St A.Costa,P.E,Cti1� .py oA��\ Po.6o(382
plBoeotw+braMwuuwdaRNmubaa�l �q`" �` oatem- N.Y.11957
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Comnrenirr-nnel h/o. .. ��OF NEW IO
3Gdb13 oo3G f .`P t mer? ,off
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AREA=54,930 sq.ft.
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION e H,`'�'�`e r c's
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW
EXCEPT AS PER SECTION 7209-SUBDIVISION 2.ALL CERTIFICATIONS R "4./0
r�,�0 6 J
HEREON ARE VALK)FOR MS MAP AND COPES THEREOF ONLY¢ r''`
SAID MAP OR COPIES BEAR TIE IMPRESSED SEAL OF THE SURVEYOR guBoiK County ,_i N.Y.S. LIC. NO. 49618
WHOSE SIGNATURE APPEARS HEREON.
ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM'ALTERED Br NOV 0 41998 15161 765NIC SURVEYORS, P.C.
MUST BE USED BY ANY AND ALL SURVEYORS UTILIZING A COPY 1516) BOX- 5020
OF ANOTHER SURVEYOR'S MAP. TERMS SUCH AS'INSPECTED'AND yt,, P. O. 909
'BROUGHT-TO-DATE'ARE NOT MV COMPLIANCE WITH TIE LAW. 7ept-Of't taws"'"tv� 230 OUTHOLOV NEY.R S197/TREE T
nce of W r
i 98 - 198
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