HomeMy WebLinkAboutMiller 11 0�
ELIZABETH A.NEVILLE 11)t OGyd•
Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold,New York 11971
`F Fax(631) 765-6145
MARRIAGE OFFICER �1
RECORDS MANAGEMENT OFFICER ;,LIQ,, $Z' 1� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ,�' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3076 R Residential x Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MERRITT W MILLER
Address 1: 1055 OAK DRIVE -
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTINO REQUIRED.
Name of Owner MILLER, MERRITT W
Mailing Address 1 1055 OAK DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 395 OAK DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 80.00 block 1 lot 33.000
Cross Street REYDON DRIVE
Building Permit Number cross Reference:
Issue Date: 9/08/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
�®� $UFFO��Oe
ELIZABETH A.NEVILLE l1,�`� y: Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS yy, � Southold, New York 11971
MARRIAGE OFFICER ` ' 1� Fax( 65
• 631) 7 -6145
•
RECORDS MANAGEMENT OFFICER 4,9 �O ��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - '� iNg
*0' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
026
Residential @ $10 or Non-Residential @ $25 Application No.3 7
Permit No.
Applicant Name 1'Il 1egi 1 ( (., m 1 LL 2
Applicant Mailing Address /O S' 01-4 {( I,Q
socr l ►fid 119` 1
Septic Tank x' or Cesspool
Brief Description of Proposed Construction or Alteration /2../'7 Odd T 0 Ai
33 X12. 6 ki ,s c'_COaud
Location of Proposed Construction/Alteration:
Owner of Property: e c r d g l CL) in d U.-L:72
/2
Owner Mailing Address: /L 5 0/4%< bR
oc; H-Cid t ivy 119'7/
Owner Property Address: .36K O R k £)1
qui �Ld 1 / y // 9'?)
Name and phone number of contact person 1110-'_1•'rl 1 I (.x.) hi i L U R '76 -63
LN
Tax Map No: Section @ Block j Lot 83
Cross Street 1L Lic-,10 it) DR .
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
74,1))/1a( W ' - + ' 2 002
Signature of Applicant Date
Received by:
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SURVEY OF
LOTS 39 r 42 inclusive Ct-
BLOCK C
"REYDON SHORES" Q
FILE)JUL Y 2,1931 FILE NO. 631
AT SOUTHOLD
TOWN OF SOUTHOLD Q
SUFFOLK COUNTY, NY.
woo - 80 - 01- 33
Scale: 1"1-: 40'
Dec. 27, 2002
MAY I, 2003 ( prop. addition 1
The locations of wells and cesspools
shown hereon are tram field observations
and or .from data obtained from others.
I pin-,f/rmlllar with the STANDARDS FOR APPROVAL
AND CONSTRuC1`/bN OF SUBSURFACE SEWAGE
DISPOSAL •SYSTEMS FOR SINGLE FAMILY RESIDENCES
gad Will abide by the'conditions set forth therein and on the
permit to construct '\‘'s\ OT �dY�2
ELEVATIONS ARE REFERENCED TO THE FIVE EASTERN 'o �#
TOWNS TOPOGRAPHIC MAPS lc rtt, r,. a 4
rte'"� ,. 1-
,
'!'+ t
ANY aL TERATION oR�►dDIT�oN To. THISSURVEY IS A VIOLATION qz,,a, �, o.
OF_SECTION MOS OF TH. ''NEW YDRK''STlTE`'EDUCAT/ON LAW.
EXCEPT AS_PER,_SECTI zg09 $D5DIt/ISION,,2. ALL CERTIFICATIONS -/ I ),,•..° 9 b ye f y .
HEREON ARE VALID-P THIS.MAP;AND'COPIES THEREOF ONLY IF /rte . 'IJ/„r�.y�,'__sk s`r.' •LIC. NO. 49618
SAID MAP OR VACS AR.'7'HE''IMPRESSED SEAL OF THE SURVEYOR � �/1r�,.t►i
WHOSE"SIGNA AP EARS HEREON. P CONIC S�'1 F'f.. - �•
, P.C.
ADDI'TIQNALL;.;,TO,CQMPL Y WITH SAID LAW TERM ' ALTERED BY ' '6311 765 - 5020 FAX (631 J 7 E5 / 9
•-MUst"-BE•�$-,8Y A"N -4ND ALL SURVEYORS UTILIZING A COPY P. 0. BOX 909
OF ANO VEYOR'S MAP. -TERMS SUCH ' INSPECTED " AND t'• 1230 TRAVELER STREET
-B QOGHT�- DATE ' ARE NOT IN COMPLIANCE WITH THE LAW.
0 SOUTHOLD. N.Y. /197(
31 .,..� .