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HomeMy WebLinkAboutDowling lLi�gff//Offi i7 146 ,ftA 00 ' Town Hall, 53095 Main Road �i P.O. Box 1179 �l Southold, New York 11971 JUDITH T.TERRY ® 0 / FAX(516)765-1823 TELEPHONE(516)765-1801 TOWN CLERK 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. 1151-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner DOWLING, JOSEPH S. Mailing Address 1 450 DEPOT LANE Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 450 DEPOT LANE Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-7162 Tax Map No. section 102.00 block 2 lot 9.000 Cross Street MAIN ROAD Date Of Last Pump Out 0/00/00 Issue Date: 6/13/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK �c3\\f�(�. '- ' Town of Southold �� � � �� Application No. G/J—'/ Judith T. Terry, Town Clerk .G 7 Residential Town Hall, 53095 Main Road - p. O. Box 1179 i \' Non-Residential Southold, New York 11971 O ® {' 0�` Telephone( �P� . (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE OWNER NAME: OWNER MAILING ADDRESS: q5----c? O` OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: 73 %, "(62— TAX MAP NO. : Section /0 Z- Block Lot ) CROSS STREET: /"// , /62 TYPE 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 A p'- .nt RECEIVED BY: Town Clerk's Office DATE: JUN.1 jj _ _ I..,U1wiCA Of VA-ti. JO4c'.c�b i - - { Cf oy.14 ey cid t.{ici, d , d o A' - 4. , 'Cr . IA if..;It -�-r - ; Garrce -- - • mI. f a+ r d d t N ►se w el / i/ I S S - L {I - .. Lp►t-4d of Y�� F—. Y-f-61 t `1 . .§V , _ 1 { ` .nreurhe:I?, a t aEien ar ed Kion , . i . , to t l survey is a violation of • / el) - 11 S-1•-1, 720'1 o`the New York Stag f!� ' Q$ _ I•! Fs-t�;ayon Lew. 14 Cc-iee a thi'su.�vcy mea ncf Laarltf 1. the terse sun'eyor'a inked rtwl or emb:e;ec1 sea!shrll nat be cQr)e de I tobeavah�tru oo3y- . 1t� A Guarentel Indicated hxoen e,- run YAP Or y., .,4{ only to the person for whom .',eurvey i r� r r 1 is Preaend,and on his.�.. to the Sea f We 5LJR.VEYt'© Ft's Imam inctitudon govern horcon andazoncy er s a +.�: _ f } J� { �^' to tha seergneos!aro' londire7 ir .i- {'� M �I LI H^ Fd-f _ii +-✓ 0i :. + 'C L A i f2 � Dov,... L I,N !a trnneforodol. - •4f3 �Yt7 t4'f'if Ttx x r'f..Y. a 1.s �, w Q++'a+gwntc/000'..-.10z �: rjt Af ! : r( 1 -rifle I rl Sthearo c c cs: , TO W NSOL)''Hrt..0`I�!' of NEy, h c�r� t i.cS Oa tS�r�}r Ossr:Y1g S tea r1:4 • �P�t;K Vqy �p� i CL.5.Csfftrif i.. - -0.4. i. 29; '3-Tei ' t 1 frfr - -JI G D,0IN ic. 1 Fais/DE.rNI -> d ' '`'° i \ r ¢ > I� e ,. 1 COY