HomeMy WebLinkAboutBaker, Theresa •
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ELIZABETH A.NEVILLE ��= ZJ�: Town Hall, 53095 Main Road
TOWN CLERK h Z P.O. Box 1179
` v i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER Fax (631) 765 6145
RECORDS MANAGEMENT OFFICER =___7�1 .�„le° Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,,,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4066-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner BAKER, THERESA
Mailing Address 1 25-19 WINDING PATH
Mailing Address 2
City St Zip MANORVILLE NY 11949-0000
Property Address 1 790 HICKORY ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-287-0772
Tax Map No. section 54.00 block 6 lot 6.000
Cross Street SOUNDVIEW AVENUE
Issue Date: 12/29/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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YOFFICE9FTHE TOWN CLERK r
cjilfFUut`+O __ Application No.�VIOU
r TOWN OF SOUTHOL ` G�. /
F�LIZABETH A.NEVILLE,TOWN CLERK .��� $10.00 - Residential -t/
P.O.BOX 1179 tri OR ��
SOUTHOLD,NEWYORK11971 � ��� $25.00 - Non-Residential
Telephone Seit °'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION - -
for RECEIVED
OPERATION PERMIT DEC 2 8 2000
SEPTIC TANK or CESSPOOL aeurhold town Clerk
Operation Permit No. 0/9� Y\
Fee $ /D
WATE /0, 9,9/0 (3
OWNER NAME: 7-11-PYe / , ` _ . ; ..
ADDRESS: , , .. ! 7P ? /` /`�`%OWNER MAILING � ��� � — `
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OWNER PROPERTY ADDRESS: 7 C 0 14 i t j( u v KS
£okthoLd /097/
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OWNER TELEPHONE NUMBER: C(D 6klicif,i, 631, 02 9"7--07na-.
TAX MAP NO. : Section 5 5 Block 6 Lot 6 i 000
CROSS STREET: coIAry I/VeA,,:
TYPE OF SYSTEM: Septic Tank New / Existing
Cesspool New / Existing
Residential I Non-Residential
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.)
4 I
i _A ltJr..J. i -
Signa -1 if App icant
RECEIVED BY:
Town Clerk's Office
DATE:
, CERTIFIED TO: -
N RA/\Alm TER RUNOFF AREA THERETA BAKE R
JOSEPH Al<V�Y BY USDA RURAL DEVELOPMENT AGENCY
N �4Si RF/ISI: N DA-ED. JUNE `'GEONO 1999 •iCTr( INC ?`
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TO -1 1 , EASEMENTS -AID SR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED
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Ni. I ' ARF Nor N4NT=r NI,--s-_-, PHYc1oALLY rt iDENT ON r;-E PREMISES AT
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Mt- ,:ME O R f_
GUARANTEE_ NL-1(.I ED ,F'UN ::HALL RUN ONO TO THE PERSON(5) FOR
r i, ! NHOM :HE s-;_„---,Ey 15 P?LPARED. AND ON HIS BEHALF TO THE TITLE COM
y F,-; f`O r•;- \ - L •'L r� / :`1,- i .
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! 1-170(--
L ` 5' PANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTIONS LISTED HEREON,
Y.�.Li: 'NrY D r A R i''NiEi t T OF HEALTH SERVICES J f
f -AND TO THE ASSIGNEES S CF THE LENDING INSTITUTION: GUARANTEES ARE
APPROVAL OF CONSTRUCTED WORKS FOR \� 1 I '_Nor TRANSFEPABLE ro ACOITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS.
A SWGL'�FAMILY RESIDENCE
S44612'00; Tnt OFFSETS ,OR DIMENSIONS) SHOWN HEREON FROM THE STRUCTURES TO
Q Lot PROPERTY L'NES ARE FOR A SPECIFIC PURPOSE AND USE AND: THERE-
/► - f �'_ JOS NOT INTENDED TO GUIDE THE ERECTION F FENCES, RETAINING
DateDEt 1 4 41 1 H.S.Ref.No. 8 '''1/4,--,...—....„....,„_.'- 9 P
�" ""`"�'tF--�..�.1�s` I s, PATIOS, PLANTING AREAS, AD(!MOIVS TO BUILDINGS AND
e ' A CONSPRuCTION.
The sewage disposal end water supply facilities at this location have been \\� .) 5a f as
•5 envies and fond to ~� t_,J,�t,.✓ vv✓i J�-,J`,' (_, , ,I
inspected e:dkr cs;,i' try t " De..Tv/eat or other ag � �79 me: a. -..r• A. :;; r,. l' 1r vjS_ \ LEARnNG IrarTS i r��-
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HICKORY .",'� O A D 71
(631) 8-5330 �f 46
Marc E Chorest. L.S.
• Successors to
Paul T. Canoti=o. LS Robert A. Kart. LS.
Good Ground Surveyors, P.C.
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