HomeMy WebLinkAboutDumblis JUDITH T. TERRY ^�'
�'. _, _� �: Town Hall, 53095 Main Road
TOWN CLERK + r � :' i P.O. Box 1179
REGISTRAR OF VITAL STATISTICS i " �1 Southold, New York 11971 •
MARRIAGE OFFICER L= >> ='". Fax (516) 765-1823
y Telephone (516) 765-1801
OFFICE OF 'FHE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1737-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner DUMBLIS, JOHN P.
Mailing Address 1 238-10 115 TERRACE
Mailing Address 2
City St Zip ELMONT NY 11003-0000
Property Address 1 HOME PIKE
Property Address 2
City St Zip" MATTITUCK NY 11952-0000
Owner Telephone No. 718-855-9612
Tax Map No. section 114.00 block 1 lot 5.002
Cross Street SILKWORTH/WESTPHALIA ROADS
Date Of Last Pump Out 0/00/00 '
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Issue Date: 8/14/91 Judith T. Terr
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold ��- Application No.
Judith T. Terry, Town Clerk Ts y
Town Hall, 53095 Main Road < $10.00 - Residential
P. O. Box 1179 Ln $25.00 - Non-Residential
Southold, New York 11971 O f �`
.Telephone o Alt . '.�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ fD; O o
DATE 944/
OWNER NAME: "pct- -buifriaLIS
OWNER MAILING ADDRESS: Z 3 8-1t7 115
, Pi o�T, N.3/, //0 o
OWNER PROPERTY ADDRESS: n`/4
T/c./C
OWNER TELEPHONE NUMBER: 2 Q,'— e 192.Li
TAX MAP NO. : Section /// Block l Lot 5. 0c-7 .2.-
CROSS
civ2CROSS STREET: ,c/LX og-TY-/
b2v.4
TYPE OF SYSTEM:- Septic Tank41E, 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 Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
NI
xCOUNTY'DEPARTMEWOFHEALTH SERVICESs'NG
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FAMILY DWELLING bP 1 Y y
' y� c• G G e
e water.sup ! and sewage disposal
APPROVAL of CONS RucnoH Ypt RES TVVO YEARS FROM DATE Oliystteme for tih P.;idence will confo •
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_ N 6 {P.p ' o,,e II _- e R/VERHEADUTE 58
�' he�9 (576) 727 022sy,X., 1901
W ' 1:� \ ,�0 ' \ • '� AREA = 1. 271 ACRES
inc.` lie I 2....••• \ oP°se ' 2 (to tie line)
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lt,l 8 a00 m �!P S `i`r °/ SSA -ERTIFIED.TO
Z Cr• 0}N _U" N l0/ F • �e(llr' ! COMMONWEALTH LAND TITLE INS. Co. •
O a Cr`' E 0 00'W JOHN P. DUMBL IS l���;�..�r.--C)
2 ` E Z'--3 'r• s ?400 SURVEY OF ELEVATIONS ARE REFERENCED i a N�4.` , i�j� �u_/ee1
2
72 //s1kl 8. PROPERTY TO A N N G V DATUM //Se', �� ' Q� „i2 `4 ,
/• /.�/3o Pl2s�//f e/27
/ AT MATT/TUCK e! 27
'14, TOWN OF SOUTHOLD E• , Z5- "`*=•••• ��_o• ' 2•' 2'C.,-""N
/p°°P SUFFOLK COUNTY, N. Y. LOT NUMBERS REFER TO z.s 3T n Q4 o �•, =E 4
'v 1000 - 114 - 01,/ - 5.2 "MAP OF POINT PLEASANT J 8/ 2Z� L.P•
Scale 1„ _ `•F0' FILED MAY 17 1916 IN THE OFFICE
OF THE SUFFOLK COUNTY CLERK. kATLR SL.-PLY A•.) S:lr!„- i,
IndZ. AS MA' NO 720 v EF(S F.i7 Tf115 R;y; I 'L"Il +
•nnn Jul 25, 1989 , O�i,�c 1.I!L CS.• 6,., //1,• i.,N.Y..S. LIC NO. 49618 -
Y f0 !•tE Si1l,i,'li„3 D: ThE SL�n;!,T � `
/
Sept. 12, 1990(revise /Ise) D�:!:fY DLPARII, ;ii D, HE..Lifl gcfi/ICLS, / �^ 1/(!
LOT 15
Prepared in accordance with the minimum c-C PECON/C'SURL(EY,ORS, P.C.
7i7
standards for title surveys as established (516) 765- 5020 1`
by the L IA L S and approved and adopted l-evi3/or)y - //3//9/ The locations of wells and cess Dols shown hereon u1 from field 1I
for such use byThe New York State Land p. P. (3. BOX 909 ,l
Title Associatin. exr�r`we// r2/r3/9 0 ob tions and or from data obtained from others: MAIN ROAD I+:1
we// /ocat`/On /2 /0/9 p
- SOUTHOLD, N.Y.'11971