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Town
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f;; THall, 53095 Main Road
® .-�ti" P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY --_`� i���, FAX(516)765-1823
TOWN CLERK ''��ri�ii% � TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1279-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner DEWINTER, RUDOLPH
Mailing Address 1 62 PLYMOUTH ROAD
Mailing Address 2
City St Zip PLANDOME NY 11030-0000
Property Address 1 4252 GRAND AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-365-3143
Tax Map No. section 107.00 block 2 lot 2.005
Cross Street REEVE ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 10/20/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK 'c�1FO(,(� -
Town of Southold �� 4 . Application No. / 7f
Judith T. Terry, Town Clerk �� " "`' T y
�-�r" '"�W �� �
Town Hall, 53095 Main Road Residential
o : . . �-;� :'�
P. O. Box 1179 cn ` `: -%ti � Non-Residential
Southold, New York 11971 c2 ®Telephone
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Telephone 1Q(
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 141 g T-
Fee $ tO.00
DATE ,a° 0 1
• OWNER NAME: AQ-CSA I o tb o
OWNER MAILING ADDRESS: (¢2- ---PL2Y1-1o071--1 ��,�
OWNER PROPERTY ADDRESS: (4 S� rZ�-,.t4; AN/ tJ s-
0L1 7ti C-K_ l�L Ctif �'.� �� l 1 s�
OWNER TELEPHONE NUMBER: Sl(n 3(50 31`{ 3
TAX MAP NO. : Section 10 -7, Block - Lot a .. (Dos-
CROSS
o5CROSS STREET:
�7 r
TYPE OF SYSTEM: Septic Tank1( e=C - New ) - - sting
Cesspool •f K,s-c. i- New Existing
Residential )C 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.)
1?(.4L., q,
Signature of Applicant
•
RECEIVED BY:
Town Jerk's ffice
DATE: / ' ,B%
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o 'formerly . , . ' - : . ., .' • , „ ,
]ry A.Smith •
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.REVISIONS •• - • • • . . YOUNG &- YOUNG f
• - FEB. 28,1985 400 OSTRANbER`-AVENUE,, RIVERHEAD, 'NEW YORK, ' • ' _'
5', , . _ JULY 22,1957
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.JAN.. 7, 1989 ALD EN W. YOUNG" HOWARD W.YOUNG
u t'•' _ PROFESSIONAL ENGINEER AND ,, - LAND SURVEYOR
,•- -, APR. 4,1989 LAND SURVEYOR. N.Y.S'LIC• NO.'12845 •' 1,,•.- N.Y.S.'LIC• NO.45893
MAY 4, 1989 SURVEY.FOR. ' ` • . • 9
OCT.. 18,1989 -
&AUTHORIZED ALTERATION OR ADDITION.10 -^'-- - -.- ,• `�'-: , • -•L' .,
HIS SURVEY IS A VIOLATION OF SECTION - '- ;�-' RU_DOLPH de W INTER; -_ t'�- `;fit • I
209 OF THE NEW YORK STATE EDUCATION , • - • ' ' - - 1 jQ - - I
' i
OPIES OE THIS SURVEY MAP NOBE SRI NO - - , - _ `
9E LAND SURVEYOR'S MED SEA: OR . - r 0 G • ,
MBOSSE0 SEAL SHALL.NOT-DE CUNS,OERE0 L 2 7
O SE'A VALID TRUE COPY, - AT- *3 AhA.-.T 4,,.A+l •'O : ..
MATTITUCK . • ICOR t k• u. UARA =r Co. • '
UARANIEES INDICATED HEREON SHALL RUN - • 'I 1N�• �r�t .50� - -•
SLY TO THE PERSON FCP WHOM THE TOWN OF - .:;:. _
JRVEY IS PREPARED,AND ON HIS BEHALF _ - SOUTHOLD `' -
THE TITLE COMPANY,GOVERNMENTAL ' N
•GENCY AND LENDING INSTITUTION LISTED •' T _ c �( _�/ /�•��f w/�/,
EREUN, AND 10'ME ASSIGNEES OF THE ' SUFF��'` co.,` ��'�•, - • �� 0
ENDING INS TITIIT LUN, GUARANTEES AHE, , /- '�
',DT TRANSFERABLE TO ADDITIONAL - SCALE: ill = 1001 -• DATE• FEB. 27, 1*.• . J ' `� 85- 136
EST IT'1T NNS OR SUBSEQUENT .OWNERS _
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