HomeMy WebLinkAboutPearlstein SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4444-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner WM ADAMS/ALIXANDRA PEARLSTEIN
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Mailing Address 1 530 CANAL STREET, 2ND FLOOR
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Mailing Address 2 f\
City St Zip NEW YORK NY 10013-0000 2 D0-2—
Property Address 1 1060 NORTH VIEW DRIVE
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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. 646-673-4531
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Tax Map No. section 13.00 block 1 lot 2.000
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Cross Street BROWN HILL ROAD
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Issue Date: 11/15/12Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
o��g�FFO(,�coG
ELIZABETH A.NEVILLEo� y� Town Hall, 53095 Main Road
TOWN CLERK r/2 me P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O Southold, New York 11971
RECORDS OFFICER Fax(631) 5
MANAGEMENT FICER ���• �►aO�� Tele hone(63 6765-1800
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 V or Non-Residential @$25 Application No.4
Permit No. 3 5
Owner Name jamL,lzAmd&uq ����t� �' ►`�
Owner Mailing Address 3 a CAfJ A t S4 d I.
Owner Property Address,fa
CA ¢ e A=A V
Owner Telephone No. /• ( t,G(� �o"7 '��
Tax Map No: Section Block Lots
Cross Street
Please check each that applies: New Construction
Alteration to Existing 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 survey with SCHD approval.)
Signature of Applicant V Ll Date
Received by:
SURREY OF PROPERTY �c
51TUATE: ORIENT �
TOWN: 5OUTHOLD
5UFFOLK COUNTY, NY e s E
5URVEYED: APRIL 25, 2010
PROP. ACTION5 MAY 7, 2010
REV. JUNE 12, 2010, JULY 27-2010
OCT. 4, 2010, FEB 25, 2011
APRIL 6, 2012, OCT. 18, 2012 �J
5UFFOLK COUNTY TAX #
1000 - 15 - 1 - 2
CERIUM TO:
WHILAM ADAMS LONG
ISL.AND
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HEALTH DEPT. REF. # c� -
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copies'
NOTES: a 4ikatgn �e ee nrern e y Ib
rlow-t'}�L ey r =Lae x accordant nn the o.-
�� � � ` fayttl�ia de F NCw Ywk Stole AfssO btbn��Proi�1pn1
MONUMENT FOUND �O 6Y{7 `' U5E5 PUBLIC KATE Lto Itnfor M"mrMa�um'vey anprlepm-ee
ale on hk hnholf to tin title coupon,,�overmien-
*' to tho as�"'es�ee of tf"�io Ienefny iny4utbn Certifko-
tkru ass rol urns/arable to oeeifbnal Ystnvlkrus
Area = 74,146 5. F. O¢ JOHN C. EHLERS LAND SURVEYOR
Area = 1.7022 Acres O�
GR/�PHI G SCALE 111 40' LAND S�P� 6 EAST MAIN STREET N.Y.S.LIC.NO.50202
I-- RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287
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