HomeMy WebLinkAboutDBM co (33) rlt'
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® i
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS : Southold, New York 11971
MARRIAGE OFFICER ® N' Fax (516) 765-1823
= �® !� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1897-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner DBM CO.
Mailing Address 1 P. O. BOX 2130
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 400 ORIOLE DRIVE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-2223
Tax Map No. section 55.00 block 6 lot 15.011
Cross Street LISA DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 5/11/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ' c3\\FF�(,�
Town of Southold Q L'� Application No. 4,7
Judith T. Terry, Town "Clerk • t� AY;;
` y
Town Hall, 53095 Main Road , .C $10.00 - Residential
P. O. Box 1179 cry ;;Ve. t ; ^ 1 � $25.00 - Non-Residential
Southold, New York 11971 O ® ''{'%"F ��••
TelephonePlt
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Crud , APPLICATION
for
III -1 /9 -Z OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
• DATE 11— —
'OWNER NAME: b 63 fl C o , •
•
OWNER MAILING -ADDRESS: P. D . 6 DX z. l 3 0
C71qEEA / ORT ( 191-14
OWNER PROPERTY ADDRESS: '-I 0 0 D R i a L v
Jou i Iry c_ ,N-1 . y. 119 11
OWNER TELEPHONE NUMBER: - 1 6 - -
TAX MAP NO. : Section S5 Block 6 Lot /s' H
CROSS STREET: L I 5a- ) 1,21 06-
TYPE
6TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New ✓ Existing
Residential ✓ 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.)
Signature of Applicart
RECEIVED BY:
•
w Clerk's Office
DATE: 6-/r /? -
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Park 11 CC `�
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Suffolk County File No 5187 � '•',
Lot 52 Lot 51
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- SURVEY FOR
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES KATHLEEN 0. MC NAMARA
SINGLE FAMILY DWELLING OR Y L LOT NO 8,11HIGHPOINT MEADOWS,SECTION TWO"
DARR 2 0 1992_HS REF NO, SOY/" AT SOUTHOLD DATE APR 16, 1992
The sewage aisoosal ar'1 t'.:{r--•:ur1ay hKt,vas for this TOWN OF SOUTHOLD SCALE 1 50'
location lane to_i:11•r^_'•- :y:IesCag::'r:zntaud/or SUFFOLK COUNTY, NEW YORK NO 92-0306
other agcncles altr,o k,Ce'�-}{''tlacr��.F•-t,�,' F .,HfAu rM011R ED ALTERATION ON ADDITION TO THIS
,t{(� •�•�^ L/"• �" � E. SURVEY O•vIOLATIOM OF SECTION 7209 OF THE CERTIFIED TO
MEW YORK STATE EDUCTION AR KATHLEEN 0 •i;••
Chief of$organ 1 Wastewater Management I COPIES OF THIS%JOVE,'NOT BEARING THE LAND TICOR TITL-i0�^•• T .
SURVEYORS INKED SEAL OR EMBOSSED SEAL SMALL BRIDGEHA. -IV • •L K
NGUT ABANTEES°INOOICAED TEOD HEREOND SMALL ECOPY RUN OILY TO -$ KV ` f
HEALTH DEPARTMENT-DATA FOR APPROML TO CONSTRUCT THE PERSON FOR WHOM TOE SURVEY IS PREPARED 2a �; O
AND d HIS BEHALF TO THE TITLE COMPANY,GOVERN- * .G
I WATER PAIN_MI S VSOURCE OF WATER PRINTE—/UOLIC_ MENTAL •GENCY AND LENDING INSTITUTION LISTEDry
R DOFF CO TAX MAP DIST 1000 SECTION BLINK__.0_LOT S,II HEREON,AND TO TOE ASSIGNEES OF TML LEMOING 'L+7� 0
•THEK ARE NO MELLOW; WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE 9�YJ
OTHER THAN THOSE SHOWN HEREON TO AOOITIONAL INSTITUTIONS OR SUBSEQUENT
■THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE OWNERS
I DISTANCES SHOWN HEREON FROM PROPERTY LIMES
WILL CONFORM TO THE STANDAR°!OF THE SUFFOLK COUNTY TO ENISTING STNUCTUNES ARE FOR •SPECIFIC t,..+1445893 4f.
OF NEAT TN SERVICES PURPOSE •ND ARE MOT TO BE USED TO ESTABLISH '>"
• APPLICANT. ""' ".p,AA_
r PROPERTY LINES OR FOR THE ERECTION Of FENCES EO IOS'
`-O 'SND SURVEY
ADDREES P-t ,'V a 130
€5,--4.,„-f.,-t.1 {�
rlgYy 'I` c/77-aa?-3 r: 2 YOUNG a YOUNG RIVE HEAD,NEWOSTRANDER AYORKE
NOTE- p=STAKE -.- ALDEN W YOUNG,PROFESSIONAL ENGINEER
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF _ -
SUFFOLK COUNTY ON MAR 19,1990 AS FILE NO 8911. AND LAND SURVEYOR N VS UCENSE NO 12845
4 HOWARD W YOUNG, LAND SURVEYOR
o MTIELOCPTVOI OFWILL(W),SEPTIC TARR(ST/SCESSPOOLS(CP)SOWN MACON NYS LICENSE NO 45893
APE FROM FIELD OIOEAMITIOOS AW OR DATA Of/TUMID FROM OTHERS
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BRANOIS•SONS INC.