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JUDITH T. TERRY .' Town Hall, 53095 Main Road
P.O. Box 1179
TOWN CLERK �vd tp
REGISTRAR OF VITAL STATISTICS rV*,
�. Southold, New York 11971
Fax (516) 765-1823
MARRIAGE OFFICER .�
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1876-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner DUNNE, STEVEN C.
Mailing Address 1 10 PICKWICK DRIVE
Mailing Address 2
City St Zip HICKSVILLE NY 11901-0000
Property Address 1 TUTH I LL ROAD EXTENSION
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-433-7229
Tax Map No. section 55.00 block 6 lot 15.049
Cross Street ORIOLE DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 4/20/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• i..
OFFICE OF THE TOWN CLERK •cOFO(ir
Town of Southold Application No./S
Judith T. Terry, Town Clerk . '
Town Hall, 53095 Main Road - ;:: : $10.00 - Residential XX
p. O. Box 1179 v' • $25.00 - Non-Residential
} Southold, New York 11971 O `" :% ••'
Telephone 0( Y► .
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No.
Fee $ '1 0 .0 0
DATE April 4, 1992
OWNER NAME: Dunne, Steven C.
OWNER MAILING ADDRESS: 10 Pickwick Drive
Hicksville, NY 11801
OWNER PROPERTY ADDRESS: Tuthill Road Extension
Southold„ NY 11971
OWNER TELEPHONE NUMBER: 433-7229
TAX MAP NO. : Section 55 .00 Block 6 Lot 1 5 .001
CROSS STREET: Oriole Drive
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TYPE, OF SYSTEM: Septic Tank 1 New x Existing
-" Cesspool1 New x Existing
Residential x 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.)
John Bertani, Builder Inc.
/6- L(41,j.
Signature of Applicant
- V Pres.
ROCOIVED
RECEIVED BY:
Tow itCberik Office "
DATE:
y' ohold Town Clerk
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SURVEY FOR
STEVEN C. DUNNE
• LOT NO. 43, "HIGHPOINT MEADOWS ;,ISECTION THREE"
AT SOUTHOLD DATE.
•
TOWN OF SOUTHOLD SCALE'
SUFFOLK COUNTY, NEW YORK NO.
U u#AuTHOR1ZEO ALTERATION OR ADDITION TO THIS CERTIFIED TO:
SURVEY IS A VIOLATION OF SECTION 7209 OF THE
NEM YORK STATE EDUCATION LAW STEVEN C. DUNNE
*COPIES OF THIS SURVEY NOT BEARING THE LAND TICOR TIT p- - EE
SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL SOUTH* "x tSCAll1l6rj,
NOT SE CONSIDERED TO SE A VALID TRUE COPY •
KGUARANTEES INDICATED HEREON SHALL RUN ONLY TO 6j'S y(
IEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED 41,
5L
D W. ),
AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN-
WATER BAIN_MI 4' _5
*SOURCE OF WATER• PRIIATE_PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED O �, (i
TAX MAP DIST 1000 SECTION 5_BLOCK_5_ Z LOT 15.49 HEREON, AND TO THE ASSIGNEES OF THE LENDING j
cRE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE +' n'' ` G
TO ADOITIOIAL INSTITUTIONS OR SUBSEQUENT *~
.N THOSE SHOWN HEREON OWNERS f
''R SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE `*'ar,-
SRM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT
*DISTANCES SHOWN HEREON FROM PROPERTY LINES ,.,,;!
SQhTO TO EXISTING STRUCTURES ARE FOR A SPECIFIC ,�.t9 , - I 4