HomeMy WebLinkAboutBranch SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 443%-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner ELIZABETH & DAVID BRANCH
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Mailing Address 1 681 WEED STREET
Mailing Address 2
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City St Zip NEW CANAAN CT 06840-0000 p
Property Address 1 5160 INDIAN NECK LANE
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Property Address 2
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City St Zip PECONIC NY 11958-0000
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Owner Telephone No. 203-966-9782
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Tax Map No. section 98.00 block 4 lot 23.000
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Cross Street ROUTE 25
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,Issue Date: 6/30/11 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
Sep 21 10 08:53a David/Elizabeth Branch 2039661617 p.3
SvFFot,��o
ELIZABETH A-NEVILLE Towa Hall,53095 Main Road
TOWN CLERK vs = P.O.Box 1179
REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER 'f' !� Fax(631)765-6145
RECORDS MANAGEMENT OFFICER ��l / �►'a� Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICER southoldtow n.northforknet
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 "/or Non Residential @$25 Application No. T__!
Permit No.
Owner Name C i wb` i`, - C��i v � r6W',c-"
Owner Mailing Address
l�e�y �o nc rte , C'_1 0(op j0
Owner Property Address Irl b 0 Lo-
Icor « A(q 11451'
Owner Telephone No. CYLEA,
Tax Map No: r� Section Block 04/ Lot
Cross Street
Please check each that applies: New Construction /
Alteration to Existing System V
Residential�_Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
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Signature of Applicant Date
Received by:
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— SURVEY OF PROPERTY
SITUATE "
PECONIC
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-98-04-23
SCALE 1 "=60'
-FEBRUARY 15, 2006
MARCH 20, -2006 ADDED WELL -& CESSPOOL LOCATIONS
SEPTEMBER 18, 2007. ADDED PROPOSED ADDITIONS
MARCH 18, 2008 REVISED PROPOSED ADDITIONS
APRIL 15, 2008 REVISED PROPOSED ADDITIONS
MAY 3, 2010 REVISED PROPOSED ADDITIONS
JUNE 2, 2010 REVISED SITE PLAN
JULY 20, 2010 REVISED PROPOSED SEPTIC SYSTEM
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