HomeMy WebLinkAboutOzolins SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4442-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MARI OZOLINS
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Mailing Address 1 P O BOX 1447
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Mailing Address 2
------------------------------ 02. o\� �S
City St Zip MATTITUCK NY 11952-0000 �01�
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Property Address 1 600 MAJOR'S POND ROAD
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Property Address 2
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City St Zip ORIENT NY 11957-0000
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Owner Telephone No. 000-000-0000
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Tax Map No. section 26.00 block 2 lot 39.013
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Cross Street OLD FARM ROAD
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Issue Date: 8/21/12 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
o�OS13FFO(�-C'
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ELIZABETH A.NEVILLE yt Town Hall,53095 Main Road
TOWN CLERK C P.O. Box 1179
REGISTRAR OF VITAL STATISTICSO Southold, New York 11971
MARRIAGE OFFICER y • ��� i Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ��l `�� "Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 y or Non-Residential @$25 Application No.
—"
Permit No.
Owner Name
Owner Mailing Address t44
Owner Property Address(Q 007
0KL ems,
Owner Telephone No.
�doz� 2-q:> 37. 13
Tax Map No. Section At& Block Lot
Cross Street DL--b FAR. . l' .L-Is
Please check each that applies: New Construction
Alteration to Exist' System
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 s y with SCHD approval.)
Cq2r/I Z'
e of pp l ant Date
Received by:
i
5URVEY OF LOT #2 I,
MAP OF "IHILLOW TERRACE FARM5, INC" "
FILED OGT. 4, Ig4q4 A5 # x5712 W E
51T) ATE: ORIENT s
TOWN: 5OUTHOLD
SUFFOLK COUNTY, NY
SURVEYED 06-23-qq
FOUNDATION LOCATION Oq-13-2000
FINAL 06-14-0I,UPDATE 08-08-2012
SUFFOLK COUNTY TAX #
1000 - 26 - 2 - 3q.13 t #1
CERTIFIED TO:
`Land now or formerly of: Lot #4
Helmars E. Ozolins
Jocelyyn S. Ozolins Nancy R. Douglass
Fldelify National Title Insurance
Compan of Kew York v
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Lot #2 5 WALLS
STILL STANDING
N - FOUNDATION OF
CP
/3p /26.� BURNED HOUSE "�' � '4B n
t TO BE REBUILT ,r
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Land now or former) of: �' M d an M.l.s.raee lar m tM as va►1.0r.0.rae
AREA = 67,-415 SF OR 1.55 ACRES Stuart Mager ywem
��`sF0 LA S JPJ� il
to�ti: a.:i.tmiI. smitionss °ij�
FEMA FLOOD ZONE X Garol Mager
JOHN C. EMLER LANDOSURVEYOR
SEPTIG LOCATIONS PROVIDED BY CONTRACTOR
GRAPHIG 5GALE V'= 50' RNEREMAD,N.Y. 11901
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369-Mg Fax 287