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JUDITH T.TERRY t �� '�• Town Hall, 53095 Main Road
TOWN CLERK Z P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS V ��,��� Fax(516) 765-1823
MARRIAGE OFFICER ®���� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER .o�
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. 3513-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner DRAKE, JAMES AND PATRICIA
Mailing Address 1 480 OAKWOOD DRIVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 480 OAKWOOD DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2914
Tax Map No. section 70.00 block 12 lot 22.000
Cross Street CHRISTOPHER STREET
Issue Date: 9/25/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK S��Fol'
Town of Southold �� �� Application No.
Judith T. Terry, Town Clerk 1,...-715,45,..:0!:.:414;:„; :••:'
$10.00 - Residential
Town Hall, 53095 Main Road --- --
P. O. Box 1179 ► ' $25.00 -
Southold,
25.00 -Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE g G'
OWNER NAME: 111 -5 Y O"#Z /C
OWNER MAILING ADDRESS: 5-Ag4! AS /6.7L44/
OWNER PROPERTY ADDRESS: 0/11,.*�' d2/_,D
,,re 2L2) 4/ _ //77/
OWNER TELEPHONE NUMBER: c_:61/6 7/
TAX MAP NO. : Section 7f.? Block Lot
CROSS STREET:,� j�j��® jL
TYPE OF SYSTEM: Septic Tank, New Existing
Cesspool / New Existing V
Residential / 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.)
Signature of Applicant
RECEIVED BY: /gi
__ : Town Clerk's Office
DATE:
AREA = 19,000 sq.ft , -
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SURVEY FOR ".}
JAMES '& PATRICIA DRAKE ` =
AT OAKWOOD PARK "'-
' TOWN OF SOUTHOLD _:I`:-'':' '
SUFFOLKCOUNTY,N.Y. ;.s.::,'
, 1000-70-12-22 '"" .
Scale: 1"-'40' , ,:. ;- 1,','-
July 18,1996 ' - • -' '
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CERTIFIED Toy
JAMES DRAKE I ,•,:;'
PATRICIA MAKE ' I .. ,r
PARAGON ABSTRACT WG i` ;Y
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• 96-213 : ; ,---;.
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