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HomeMy WebLinkAboutDors ®��FFOLKc®G_= It% ® T Town Hall, 53095 Main Road ‘7194,„' '`� P.O. Box 1179 _• ®1 IL •�`a®1►�� Southold, New York 11971 JUDITH T.TERRY -�,,,� ��� FAX(516)765-1823 TOWN CLERK 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. 1556-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner DORS, JOAN K. Mailing Address 1 900 GARDINER'S LANE Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 900 GARDINER'S LANE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-2305 Tax Map No. section 70.00 block 8 lot 7.000 Cross Street CLEARVIEW AVENUE WEST Date Of Last Pump Out 0/00/00 Issue Date: 10/23/90 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK c��FFO(,r� Town of Southold � C'� '- Application No. /.5^f Judith T. Terry, Town Clerk y L/ Town Hall, 53095 Main Road : -$10.00 Residential P. O. Box 1179 • t $25.00 - Non-Residential Southold, New York 11971 Telephone _Q( lor , `j►�'; '�� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE /d - 'OWNER NAME: (_ je9A •f o�CS OWNER MAILING ADDRESS: �� -1.e-/ /V/ / / 97 / - OWNER PROPERTY ADDRESS: 77 S OWNER TELEPHONE NUMBER: 766:-c=t TAX MAP NO. : Section 7° • - Block f - Lot 7 CROSS STREET: oLPA/z '/ew 4 2 /i/G- 4/�'S% TYPE OF SYSTEM: Septic Tank New Existing Cesspool ✓ New Existing Residential ✓ Non-Residential DATE OF PREVIOUS PUMP-OUT: O /✓� 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 A plicant RECEIVED BY: lL i /6-1-e---(e..._ Clerk's Office DATE: 7(D — / S--�� t tit t 1 , ,• ` .....l.l-�-771,., <:.----_ r-rtJ_ 3 ! `c.�, 1 S`i t if ><rs.a �,P;I' I '��; • I $ F( S 1 ,�.y"tl''�{..`. �: �'?'.t��. 'moi . ' f - _ y N ; Llnei thori Erterstlio r or addition ! R ^ '� to thss ssR v lot, :.;:trthr!vses.:01,1iPmttet:;;Ns'Iocoulrallt: • rpec lan7^ .5tat3�". ?v Sdutootlon1rt LBrin9;{!F Co�SEsof tYsi'� s1 'y Oho!_nds,n' l d w N., y ' �. i_ sra,b�;sa�d�,t snarl not be considered int Gri ON 1 , , y to be 3 vele(tq o cosy. G �� ! p`. _� �' Guzrantea3 in rated hereon slyall run i ;" •;> `� 0 '` , 67E' }-c--— 55'� ; , onSy m tha pirn .n#or v.'�:mr til3 carves) �; } �,b t L is Grevare:i.an:on his bsr•:.J to tem i ._ © " 4`. . r 81?lsi comb any. 'eernme st:S a�ancy and f w n 4.4., %end;lQ m tstuts llst::c nor pan Mrd to the ccs s,lard .f the lending insti- tution. I ttsilan.Cs Ei ant are not tr ansto transferable 7 dry tro V." to edditlonal east t icons or subsequent s Z .r owners. — y a f4 oT Ir Z1 ,,G;ic F°ii,F: f / / sy',� 1:1TT ( i At'-'t r.‘�tc, :0 \� N't")4y 0._ I ;> V b4 S+rca�E: i�s " �� • • •QCs �L- t ' 6r 0); +r -- 4`,- ~ ` - p�af� t�c>rs4� •�.- eo-i s4:r' ,_moi QC-ft,'r; K C,-_, v . V- .'''l e`''t,-,:,=ti.. �. s ,. ' a ( r jt a —_ t.3 ::, '~,k,1+�.,Ye: rf•.LCect.F -?-,-r iirr'� u-•'�i"` `rr v(•.t •,h,, •� ;',A4`-'',2 < It ``�.e,.J, �1'"_"S ,e'i--.' ksr' 1n- -.moi ,�'' .,a. r �' - C/t,t 1:.. . . '4 T 43 6.77. ,., T"7 4-41 '74 CK1s1' t' ::14.r �.J y' td' . J..,,1E;'d 5:ii` . .;13ne 1`t'. 1-- -T;.'_. AT VAN 1-<',.a 4r ..: r.' N ,J _J- -"---• -...� -