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JUDITH T. TERRY ` ' ! *1 Town Hall, 53095 Main Road
TOWN CLERK 1 =: 1 P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS 1 ^'- Southold, New York 11971
MARRIAGE OFFICER 2 ' �. Fax (516) 765-1823
11-4./?/
Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1612-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner D B M CO.
Mailing Address 1 P. O. BOX 2130
Mailing Address 2 443 MAIN STREET
City St Zip GREENPORT NY 11944-0000
Property Address 1 HIGHPOINT MEADOWS, LOT 18
Property Address 2 TUTHILL ROAD EXTENSION
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-477-2223
Tax Map No. section 55.00 block 6 lot 15.001
Cross Street ORIOLE DRIVE
Date Of Last Pump Out 0/00/00
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Issue Date: 1/17/91 Judith T. Terri"
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ' c��FFOLA-e'•
Town of Southold �Q '0�•., Application No. /l /o;-i
Judith T. Terry, Town-Clerk' i', �:�}
Town Hall, 53095 Main Road a . ;a,r $10.00 - Residential
P. O. Box 1179 0-3 ^. ••` y°r"" * h�i
w ,�: � �_,,:,�;� $25.00 - Non-Residential
Southold, New York 11971 O ® .
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE IDecembe t 6, 1990
'OWNER NAME: V B M Co. •
OWNER MAILING ADDRESS: 443 Main S reef, P. 0. Box 2130
Gneenpotrt, N.Y. 11944
OWNER PROPERTY ADDRESS: flighpoint Meadows Lot #18
TuthJJl Rd. Ext., Southold, N.V.
OWNER TELEPHONE NUMBER: 516-477-2223
TAX MAP NO. : Section 55.00 Block 6 Lot p/o 15.01
CROSS STREET: 0tuole DitAlve
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New x Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT:
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
i y
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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'� SURVEY FOR ,
LAURA TEPE
LOT NO.18, "HIGHPOINT MEADOWS, SECTION TWO"
AT SOUTHOLD DATE• DEC. 13, 1990 -
TOWN OF SOUTHOLD SCALE 1'•=40'
SUFFOLK COUNTY, NEW YORK NO. 90 - 0985 .
r UNAUTHORIZED ALTERATION OR A001TION TO THIS CERTI F IED •
SURVEY R A VIOLATION OF SECTION 7209 OF THE .
NEW YORK STATE EDUCATION LAW
*COPIES OF THIS SURVEY MOT SEARING THE LAND D.B. `�'' +Yy� ,
SURVEYOR'S INKED SEAL OREMSOSSED SEAL SHALL TIC',R T •UAR
NOT SE CONSIDERED TO SEA VALID TRUE COPY BR •G •.- PT•I NATTG •L ':ANK
. AGUARANTEES INDICATED HEREON SHALL RUN ONLY 10 ' 0
HEALTH DEPARTMENT-DATA FOR APPROM4L TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED •
AND W HIS BEHALF TO TME TITLE COMPANY,GOVERN-
• MENTAL AGENCY AND LENDING INSTITUTION LISTED Lt 4- _
M NEAREST WATER SAIN_MI - *SOURCE OF WATER PRINTF_PUBLIC_
M MIFF CO TAX MAP DIST 1000,SECTION_§,§_'LOCK �_LOT p/o .I HEREON,AND TO THE ASSIGNEES OF THE LENDING y-
*THERE ARE ND OWNIELLON, WITHIN tOO FEET OF THIS PROPERTY MISTITUTION GUARANTEES ARE NOT TRANSFERABLE
TO ADOITIONAL INSTITUTIONS OR SUBSEQUENT
OTHER THAN THOSE SHOWN HEREON OWNERS 4 �O, 4RS9�
N THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RI10E1 CE -0
iF0lsTAMCES SHOWN HEREON FROM PROPERTY UNES -!� Off'
WILL CONFORM TO THE STANDARDS OF THE SUPTOLK COUNTY DEPARTMENT TOEXISTIMG STRUCTURES ARE FOR A SPECIFIC
OF WEALTH SERVICES PURPOSE AMO ARE NOT TO BE USED TO ESTABLISH
APPLICANT, - PROPERTY LINES OR FOR THE ERECTION CF FENCES Ado"-
-ADDRESS - - _- _ „.
l
ul R p 400 OSTRANDER AVENUE
NOTE. A = STAKE
SUBDIVISION MAP FILED IN THE OICE OF THE CLERK OF -ICc 4 W YOUNG,PROFESSIONAL ENGINEER -
SUFFOLK COUNT" ON MAR.I9..t:90 AS FILE NO.8911. • 'A•%C' LAND SURVEYOR N Y.S UCENSE 1--' 12845
s\„ A ; POWARD W.YOUNG, LAND SURVEYOR
m N TINE LOCATDN OF WSLLIW:,'I:FKIC TAAKISTIS CESSPOOLS(CP)SHOWN HEREON •• ,' , N Y.S.LICENSE NO c45893 -
v ARE PROM FIELD OSSE111MTIL?.�S.w/.:OR DATA OSTAINED FROM OTHERS --"� ! Z•Q•