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Home My WebLink AboutPershouse �O��QF S0VryOl ELIZABETH A.NEVILLE O Town Hall, 53095 Main Road TOWN CLERK l P.O. Box 1179 REGISTRAR.OF VITAL STATISTICS v' Southold, New York 11971 MARRIAGE OFFICER �Q Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER OIjY Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER Comm� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4293-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner PERSHOUSE, GAYLE AND OTHERS ------------------------------ Mailing Address 1 106 ARLINGTON ROAD ------------------------------ Mailing Address 2 ------------------------------ City St Zip WOBURN MA 01801-0000 -------------------- -- ---------- Property Address 1 14895 MAIN ROAD ------------------------------ Property Address 2 ------------------------------ City St Zip EAST MARION NY 11939-0000 -------------------- -- ---------- Owner Telephone No. 781-938-0355 ------------ Tax Map No. section 22.00 block 3 lot 38.000 ------ --- ------ Cross Street DAM POND ------------------------------ ---------------------------------- Issue Date: 10/20/05 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) o�°SUFFv��o G ELIZABETH A.NEVILLE co y� Town Hall, 53095 Main Road TOWN CLERK Z P.O.Box 1179 REGISTRAR,OF VITAL STATISTICSOFFICER O,L � Southold, New York 11971 Fax 31) 76 -6145 RECORDS RMANAGEMENT OFFICER ��01 �aO�� TeleP hone (6 1)5 65-1800 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 No yZ.C1J Permit No. `�3 21 R Owner Name Gayle L C S iep44 S 6yl Gi II(f is -C 5r, MV-k. Owner Mailing Address G-6i u 12 14aff-f�1� d�Zl/ Wl< ULbiq cui 106 Ao lyrhot, need , Woburn (YI c, Q 1PO/ Owner Property Address M4 I'm 'e a Sf- y-n Cvr-i6 V� t� y 1 ) Owner Telephone No. �:q 7 g-ac ' Tax Map No: Section 22 .OU Block Lot 3 S ,MoD Cross Street Y1 EXE �0 `IJ anM Pl)' 4 Please check each that applies: New Construction Alteration to Existing System Residential I// 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 J bate Received by: i SOUryo ELIZABETH A.NEVILLE �� l0 Town Hall, 53095 Main Road TOWN CLERK i[ l [ P.O. Box 1179 REGISTRAR OF VITAL STATISTICS COD Southold,New York 11971 MARRIAGE OFFICER • COQ Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER 0��. Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER CDU �� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD VASTEVMTER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3321 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool 13EPMIT ISSUED TO: Name : FRANK VAUGHAN Address 1: 106 ARLINGTON ROAD City St Zip WOBURN MA 01801 Descripton of Proposed Construction or Alteration ALTERATION/ADDITION TO EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FRCM ADJACENT WELLS BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner VAUGHAN, FRANK ------------------------------ 14ailing Address 1 106 ARLINGTON ROAD ------------------------------ ------------------------------ City St Zip WOBURNMA 1801 -------------------- -- ---------- Property Address 1 14895 MAIN ROAD ------------------------------ ------------------------------ City St Zip EAST MARION NY 11939 -------------------- -- ---------- Tax Map No. section 22.00 block 3 lot 38.000 Cross Street MAIN ROAD ------------------------------ Building Permit Number Cross Reference: Q. ---------------------------------- issue Date: 7/08/05Elizabeth A. Neville -------- Southold Town Clerk (TOTidN SEAL) SUR-r- OF P-Riii,"OP-E-RTY � S ATE . UFJF'OLK ,COUNT, NEW YO / Ugh ��- SUFFOLK COUNTY TAX # � t �r , 1000-23-1-2. � p0 NpW ti \ \ OO \(xo? — SURVEYED: JULY I, 2004 ` �aernQb��n�,,,-' �N�4°3p�� `m Q AMENDED: AUG. 13, 2004 ` _ 9 / � _ — — nom 1Q�pa1i�' o/ `� GS � Pm dI IF®ffo \ I .- _f 0a S C Eteg])Ige�®ID cP Illnspne Jr. 6° Gayle Pmhouse na / I \ \ ;\ \ \ I �„ -Z--- d 1_Q ♦ \ \ / / vn°i ♦♦ �. :�.a��'., :q„ "D' -'-?':,es+dli n,;i= - - fri°`-sri.� - - - .♦trp 3` — — — _ — — _ — .r � 2 � —+ryt, k .,�:%'. .'�;:• "6!;, .'.I{�`.':\",- ry is Y ,,,5., .'t;i, - _ �'2 S: :/ H)�„ t ♦:�''•`�'.:\,` .1.� � � �'.��'"rt�'` 1, .-t+" ' �i`Yt, „\, e{' �''r-' •s �--?Y ,gt.. fG,��Z w.;�,,.'w„ ,.�. .0, .,K, �„"'�:."tto,:,q",w..:, ;,:G%.o+4..+„i9,':. _ � n p'< w..ra.W...._ � _–. M.:t¢.., 1S3N3.L lsnZ11 'u�3d0 I ,1 '�oi�3weoN1�o3Mo-3y=nbno \ 1 -77 AN k 10 �c ell 44 ot AA 'Poo I / ti ar SnoN e hooa5 et \ I alp, // 111 1111 I in � Ix 1 "06Ne 1 \ 1 1Z x x i / AO .._. _....—_. 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