HomeMy WebLinkAboutViets SCUTFICLD V* TEVIATER d SPOSAL PERM T
CPERATI CN PERM T
SEPTI C TANG or CESSPOCL
Oiler at i on Per M t Nb. 4465-R Resi dent i al X Non-Resi dent i al
Fee $ 10. 00 New X Exi st i ng
Wre Cf Owner Rl CFWRD & RCSFJIAW M ETS
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fAiIing Address 1 2160 PCE AVENLE
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Wi I i ng Address 2
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O t y St Zip EAST IVEADON W 11554-0000
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Property
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Property Address 1 1570 JAOCBS LANE
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Pr oper t y Addr ess 2
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O t y St Zip SCUTFICLD W 11971-0000
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Owner Tel ephone W. 516-384- 1096
Tax Nbp W. sect i on 79. 00 block 7 1 of 31. 000
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Or oss St r eet LEEVWU DRI VE
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I ssue Date: 4/24/ 14 D i zabet h A Nevi I I e
-------- Sout hol d Town d erk
(TOIN SEAL)
r
�oSUFFo��.�
ELIZABETH A. NEVILLE o Town Hall, 53095 Main Road
TOWN CLERK CCA Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O Southold, New York 11971
MARRIAGE OFFICERy • � Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ! `�►a 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 @ $101—or Non-Residential @$25 Application No. �pC7
Permit No.
Owner Name Gs C,A4 Q
Owner Mailing Address ( jg D go ¢- A ye, u
Eus+ ,tlc,udaav zu Lb-!; Y
Owner Property Address 1,5-70 J'0-S_ a 11!E;
�5oH1 'totd /L' X llq7
Owner Telephone No. .5 1 `t 0 ce
Tax Map No: Section 7R Block 7 Lot 31
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.)
b
Signa ure o plicant Date
Received by:
` LOTAREA:40,000 SQ.FT.
fiaMMY TRUING
�. S.T
CORNER A 45'
R B 26'
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LEEWARD ACRES AT BAYVIEW
�F SITUATE AT
BAYVIEW
TOWN OF SOUTHOLD
O SUFFOLK COUNTY, NEW YORK
�Q S.C.T.M. DIST. 1000 SEC. 79 BLK 07 LOT 31
0 20 40 60 80 100 120 140
SCALE: 1'=40' DATE:OCTOBER 8, 20
).918 ACRE I FIED TO:ROSEMARY VIETS
RICHARD VIETS
ION DIMENSIONS ,10.:2012-211
3P1 CP2 '0.: 5599
58' 46' JUNE 4, 1971
33' 40' ,,IONS: -
;'. FOR HEALTH PERMIT 12110112
TO 5 BEDROOM SYSTEM 210413
')A TION LOCATION 7116113
URVEY 1114113
PO
2 6 �oF
Si IAF. CO.HEAL7r.
LICENSE N0'1?517 63
1 f OF WA 7. -
HANDS ON SURVEYING
26 SILVER BROOK DRIVE
FLANDERS, NEW YON(
11901
TEL:(631)369.8312-FAX:(SJI1},�8a8313
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