HomeMy WebLinkAboutEllwood of
cgif
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK z' � P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
= �. t�, Fa (516) 765
MARRIAGE OFFICER
4/ x �� ' Telephone (516) 7665 5-1 1801
•
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1818-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ELLWOOD, WILLIAM A.
Mailing Address 1 P. O. BOX 1241
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 195 TRACK AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6271
Tax Map No. section 137.00 block 1 lot 17.000
Cross Street STILLWATER AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 12/10/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK •c3vFFOur - -.
Town of Southold �� <. . CQ Application No. h'
Judith T. Terry, Town Clerk `
Town Hall, 53095 Main Road $10.00 - Residential V
P. O. Box 1179 E � �' ' ` $25.00 - Non-Residential
Southold, New York 11971 ��`
Telephone o o
.(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0, 00
DATE /2,/ ''/q/
OWNER NAME: 1Ah LLiVir IAA A - ELL (A)0(:)? ,
' OWNER MAILING ADDRESS: PD boX
C JTLk 6-0 q �-
- - ---- -OWNER PROPERTY ADDRESS : I q --T-Ted
c%C
Cc1 c cG o 6-UE / ( 93
OWNER TELEPHONE NUMBER: 676 734 (r -71
5v CroLic cry,
TAX MAP NO. : Section 13-1 -j - /) Block Lot
CROSS STREET: STILL (Al
TYPE OF SYSTEM: Septic Tank New Existing ✓/
Cesspool New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: A7/i4}
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.)
mwiti„,
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
--• - - --- - ---....------ _ __.—__ ----
v. 1
� I�NAUTµORI1ED ALTERATION:Dv:
R ADDITION.rr I •
EOTµ15 SURVEY 1SA VIOLON STATEW SECTION 7209 Of THE NEWORK . .,. ... :
'� L EOUGAflON LAW pEARiNO+ THISSURVEY MNOTI, . COPIESOFt CONSIDERED�z THELANDSURVEYOR'S INKSEAL O
71
•
{ EM$OSSED SEAL SHALL NOT
`� :-.2:.
TO BE A VALID TRUE COPY..
'� Tµ1 S.JE4I
GUARA:067:114850 INDICATED HEREON SHALL AUN
• �r ` ONLY E PERSON fOR W
HOM TO THE
l • '' y t i IS PRD. °341)-(3t4
ND ON HIS EEHALF ENCY AND
1 r ii. 4 $ 1 7 M O 6' d 1•--_ ^•, •TITLEANY.GOVERNMENTAL AG
2 ' r- -__ I 8 >,' LENDSTITUTION LISTED HEREON•AND
'' TO TµE ASSIGNEES OF THE LENDING INSTI•
y 1UTION.GUARANTEES ARE NOT OTR SUSREGTIENT
t'2 ! C 1� TO ADDITIONAL INSTITUIIONS
•
• } _CIs, WNERS. 4•
•
ts
O • ri ,? c1 3 AIA/ LE
fOY14 _ ,7'� 80• pe01 ,^' .�.•
•N Garage 3 • 1 a a di { ,
r. ,z r.\,) j ,•
� - , I a a.rt
Q y .6.114,6:!,,
rdd. �f •" • 6 dl.'A
•
A/I41- OP PTOP RT Y �l�>Fa 'icr�x:'t•efer." a'' cls�rurrrad e/car flan
SURVEYED FQ12 - • • Z.F.0- i.e.,. ;,OQd. d fr e LLi/ ' -iv. w'. cor.
• -4)- zt^ ce. s .,ter- . ‘ • ' . 4 .= •h,fre
PAT I ,`� A. st WILLIAM LI, M /1 . L L WOOD 0 > ry a! , ' _; cl rrf_�ru rrl EM t� .
• ?"Y�' r fd[e� .M� Sdu#'fit,Id �Se.tVl Ince ..
AT
• - ,-:=:eal.1,C•;add 1.o` Arrrerr4tx .,Tri`le Irr", drarrLe
GU 7-CHO U ', fel. Y. , - = .ca. • as surveyed ApYi f , 1975.
ccrrie :. gyp'-/., _ ,�:v�r' rl ' ',Srd'1 °7 ./qi/ 'T� . •
e
VC‘
I 1/ !1'-/'-''L'c�•r•:> rcfr to " h a o 5e 4
cflr1 - _......, _.�. " _._..__.
7 w - T"�r�t+N, /V df t4, �'
Neld" / o' �r7/I L/ceri s• d ed Lo ••�..wr✓ew'ydr.4
.�'Lrffi/k Co, C/�•r.k'S a�fte alb Ali ri0. 1;80 . G�'�:>'r ori'', N. Y. .