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HomeMy WebLinkAboutEgan (2) 4t re7ke JUDITH T. TERRY Town Hall, 53095 Main Road TOWN CLERK ® P O. Box 1179 REGISTRAR OF VITAL STATISTICS .�` Southold, New York 11971 MARRIAGE OFFICER ,�� Fax (516) 765-1823 i!' 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. 1921-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner EGAN, SUZANNE Mailing Address 1 315 WEST 22ND STREET Mailing Address 2 City St Zip NEW YORK NY 10011-0000 Property Address 1 BROWNS HILLS ROAD EAST Property Address 2 City St Zip ORIENT NY 11957-0000 Owner Telephone No. 212-242-7448 Tax Map No. section 13.00 block 3 lot 12.000 Cross Street SOUNDVIEW DRIVE Date Of Last Pump Out 0/00/00 Issue Date: 6/12/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK c.3VCQFFOUre- Town of Southold � . Application No. /Y2/ Judith T. Terry, Town Clerk �� �► - Town Hall, 53095 Main Road v A $10.00 Residential P. O. Box 1179 u-3 _ �"�4 '_= $25.00 - Non-Residential Southold, New York 11971 ` Telephone _ ,( (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD 'WASTEWATER DISPOSAL DISTRICT APPLICATION for - J OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ 1'.0• -.off, DATE OWNER NAME: SV-21-4,a&-t, OWNER MAILING ADDRESS: to .X)N c' 1 NN NA-1 LCivi1 OWNER- PROPERTY ADDRESS: ebr prwt_ OWNER TELEPHONE, NUMBER: Z 1`TLQ TAX MAP NO. : Section 13 Block 3 Lot 12_ - CROSS STREET: J (Z Aft V V �•%Y1� �4`V✓Z_ TYPE OF SYSTEM-: Septic Tank- - = New Existing Cesspool '�, New Existing y 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.) C akAA L .A . LA ignature o App i Tnt RECEIVED BY: - -- -- _ _ -_ ,. Town Clerk's Office • DATE: - . . * - MAP OF DESCRIBED PROPERTY SITUATED AT HILL , ROAD ORIENTBROWN,S - TOWN OF SOUTHOLD O.M. .v/R _ ' SUFFOLK . Y. our POLE _ �-� /58.72 CO.,s 50'S' �om._ S.45°/9 20 E. MON. FND. OF N�Lq sem.O • • „42 s e 1 G' off© !1 DpN��r 146 N :-'' tl,_,;::.4 fe co\ it Cl• 42 3 /1 0' STORY i _.s,. FR HSEt . _41,:cf,-z_..- , ,._ 1,4 : ` N c, �O. 4926 .AA s �c� I 24.0 LOAtd mac ' O CERTIFIED TO• F/RST AMERICAN T/TLE CO. SUZANNE M. El .t/ N°AN 605-S-/06/ LK `` PECONIC ABSTRACT CORP. / . Q W 3 • kk 01' 1,41 WI 0 • seLI) La and o surveying & *°, ��; y engineering P.C. �• ' I N.4/°42'00"W. /5796' ® west main street its 1ri verhead, .new york 11901 `' �I N/F LUCE (516) 369 -1717 i MAY 14, 1985 Job N9- 85-850 6j 1000-013-03-12 Scale: l"=30' _ c