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SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4368-R �' Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner PETER ANDERER
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Mailing Address 1 755 BROWN STREET
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Mailing Address 2
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City St Zip GREENPORT NY 11944-0000
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Property Address 1 SAME AS ABOVE
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Property Address 2
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City St Zip 00000-0000
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Owner Telephone No. 631-477-1967
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Tax Map No. section 48.00 block 3 lot 1.700
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Cross Street 7TH STREET & BROWN STREET
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Issue Date: 1/30/08 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE ~� �� Town Hall, 53095 Main Road
TOWN CLERK Z P.O.Box 1179
REGISTRAR OF VITAL STATISTICS O Southold, New York 11971
MARRIAGE OFFICER y� ' ��� 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 / or Non-Residential @$25 Application NoL4a(p g
Permit No.
Owner Name
Owner Mailing Address ? s �D
(;-P�;f&) POO- LY
Owner Property Address S,o'k r
Owner Telephone No.
Tax Map No: Section q9 Block Lot 5- 1
Cross Street 2 4" 5-'� '� s"Y_
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 dApplicant Date
Received by:
SURVEY OF CERTIFIED TO:PETER ANDERER
LOTS 40, 41 &
PART OF LOTS 42 & 45
MAP OF JOB NO.:2006-207
MAP NO. 369
GREENPORT DRIVING PARK FILED:DECEMBER 1, 1909 AND s
SITUATE A T
REVISIONS:FOUNDATION p Nq
LOCATION 8/14/2006 'S
GREENPORT FINAL SURVEY 7/20/2007
TOWN OF SOUTHOLD USAN Jalernaxsem 40 809}O _
SUFFOLK COUNTY, NEW YORK
S.C.T.M.DIST. 1000 SEC. 48 BLK 03 LOTS 14& 15
15 8 0 15 30 45 60 75 90 105 120 135 �w' `� o 66� ��
SCALE: 1"=30' DATE:JUNE 22, 2006
LOT AREA: 14,946 SQ.FT. =0.343 ACRE LICENSE N0. 050363
WATER SERVICE PER OWNER AND NOT GUARANTEED
SANITARY DIMENSIONS PER INSTALLER AND NOT GUARANTEED HANDS ON SURVEYING
26 SILVER BROOK DRIVE N
FLANDERS, NEW YORK
11901 `
v .~ + TEL:(631)-723-1954-FAX.•(631)-723-1329
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