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JUDITH T.TERRY • Town Hall, 53095 Main Road
TOWN CLERK _: - :=k. P.O. Box 1179
tP, r Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER ‘‘,#. 't
�,o X' ��'t��' Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER J� .00 Telephone 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. 3712-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner COLELLA, ANTONIA AND ANNA
Mailing Address 1 3330 NORTH BAYVEIW ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 3330 NORTH BAYVIEW ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 79.00 block 2 lot 3.006
Cross Street
Issue Date: 10/29/97 Judith T. Terry
Southold Town Clerk
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(TOWN SEAL)
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OFFIC -OF THE TOWN CLERK c�vFFOC,r '-
Town of Southold �Q Application No. 3 7/0)-)Judith T. Terry, Town Clerk ,k, .)
Town Hall, 53095 Main Road -
•r - , ,. . ; $10.00 Residential
P. O. Box 1179 '_,, t f.. Z' $25.00 - Non-Residential
Southold, New York 11971 O `''
Telephone : l .t y1 '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
cw Operation Permit No. /!o`ia.
a.
Fee $ /O
DATE /o/z,z `j7
f
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w OWNER NAME: ,4/✓TO/V/1) /9/l//VA C'01 ErZ.- /
OWNER MAILING ADDRESS: ._.,go /1/049:7/1/0/1/049:774o ,7 ,(�//9)/Uiecu /eh,
�5- 07-1/0�h Al/ _//7 7/
OWNER PROPERTY ADDRESS:,3,5,5 /UokrH oegyviecUrC�
✓✓ So 07--H cOL• iv / r
L Q OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 7 Block , Lot
CROSS STREET:
.J
TYPE OF SYSTEM: Septic Tank ✓ New v Existing
/ Cesspool v/ New ✓ Existing
Residential ES Non-Residential
C 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 u o Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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NOTES \
I. II = MONUMENT FOUND A= STAKE FOUND
2.SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK .
OF SUFFOLK COUNTY ON OCT.16, 1985 AS FILE NO. 7987.
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES CERTIFICATION SURVEY FOR:
"I AM FAMILIAR SEWAGE DISPOSAL MSTANDARDSTH THE APPROVAL NCONSTRUCTION
RO
SYSTEMS FOR SINGLE FAMILYESDENCESANDWILLABIDEBY THE CONDITIONS ANTONIO COLELLA 81 ANNA COLELLA
SET FORTH THEREIN AND ON THE PERMIT TO CONSTRUCT." LOT NO. 6 , nJAMES W. DAW S O N II
APPLICANT'S SIGNATURE:
APPLICANT: At: BAYVIEW Town of: SOUTHOLD
STREET ADDRESS: Suffolk County, New York
CITY: STATE: ZIP CODE:
TELEPHONE NUMBER: Suff. Co. Tax Map : 1 1000 1 79 L 2 1 3.6 [
District Section Block Lot
CERTIFIED TO:
Young & Young, Land Surveyors ANTONIO COLELLA
400 Ostrander Avenue, Riverhead, New York 11901 F.�+ TLE INSURANCE COMPANY
516-727-2303 '-;L T. ,
��T OCT 1 4, 1997
Mfr ~�1 ' ' MAY 2 0, 199 7
r ,,` ,-`� 'f j / MAR. 26, 1997
.. im �,��y'r* ., JUNE 16, 1994 I
Alden W. Young, Professional Engineer & Land Surveyor ,�fl'i,y_ttlYlj„; J 4i � . DATE :MAY 9, 1994
Howard W. Young, Land Surveyor -' p - SCALE :1"= 50' '
N., Thomas C. Wolpert, Professional Engineer ` � JOB NO. :94—0220
{
Kenneth F. Abruzzo, Land Surveyor 499* ' -' SHEET NO. :1 OF 1
7.71 rii
UNAUTHORIZED ALTERATION ON COPIES OF TNS SURVEY NAP NOT REARM MED SEAL ER DISTANCES SHOO HFrA•.1 l EMI PROPERTY LINES CERTIFICATION 4i” .: 01 BRILLS.IOM ONLY 10 THE PERSON FORARE°AND ON HS SOW 70'ME TIRE COMPANY.00YEENNENTAL MIC I THE SURVEY THE LDC.ATIAi ON OF YIE11D CV).SEP11C
MOLD CF SECTION OP THE AMMON TO MS SURVEY IS A O BOOMED SEM. HALL TIE LAND SURVEYOR'S
CONSIDERED 0 PURPOSE AND ARE NTO DORM OT �TO ESTAD SH SPEOFIC O IS PItEPIZEO1U ION LISTED IERE% AND TO THE AAQ OF DE N9NO NSRIUTML CV AND 0 HEREON(All$F 0of�11/ATONS
NE11 MCC STATE EDUCATION LAW. 10 EE A VAUD TRUE COPY. PROPERTY MEI OR FOR 4RECN01 Cr FENCES. CERTIFICATIONS ATE NOT TRANSFERABLE 70 ADINRONAL DISRNTIONS OR SUBSEQUENT OWNERS. MID OR DATA CNTANED BIM OTHERS. I