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JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971 •
�� Fax (516) 765-1823
MARRIAGE OFFICER ® ®� t
11/4°6•l ► 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. 3120-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner ENNIS, GARY R. AND MICHELE D.
Mailing Address 1 90 20TH STREET
Mailing Address 2
City St Zip WADING RIVER NY 11792-0000
Property Address 1 HORTON AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-929-0539
Tax Map No. section 141 .00 block 2 lot 9.000
Cross Street SHIRLEY ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/23/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �c3vVFO(,(-,,=
Town of Southold �% ,:: - �Q� Application No. 3(� v
Judith T. .,;rbrry, Town Clerk . , �''�` ;$„:::i., �'�
Town Hall, 53095 Main Road 4 ..4 $10.00 - Residential
P. O. Box 1179 crs ti• K , $25.00 - Non-Residential
Southold, New York 11971 O ,(Eli1-.._--:--c' - $
Telephone -O.(.' 0,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL -
Operation Permit No.
Fee $ DATE 7/o /93
OWNER NAME:
g--7 b` 1 /1/G/_/F-- c -I). L_Ai if...)/
OWNER MAILING ADDRESS: 70 -2-0-?----) r
Ge) 406, & 2 x y ', z
OWNER PROPERTY ADDRESS: 3 gr r 7-- S,�ze__C',/S4D
/l,4-77trzcc K
OWNER TELEPHONE NUMBER: qz7--03) ,
TAX MAP NO. : Section /y( Block 7-- Lot
CROSS STREET: . ---/i g-C.
TYPE OF_SYSTEM: Septic Tank � New V// 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.)
U --- JP_- -,vG z-Pz
v
` igna re of AID. . . t
RECEIVED BY: - LX)/_/(----4---- R
own Clerk's Office
DATE: /l-G7 [/2 3
. -—7
Al The water supply and
Q/dy Depf 2/¢07 +'6j1'C 1' `�O o''r+ r systems for thisesidenceawlll conform SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
C I ° yFOR APPROVAL OF CONSTRUCTION ONLY
rie l ja p/' o"
to the standards of The Suffolk County
•
Department of Health Services. 93-80-07
\ • f i`il DATE HS.R . NO.
9 fes! bor»9
I'P ' cr
o.v+�l15 o'{ h o, fops.;/
p s Io° ,�� Is s APPROVED
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05.69'
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`O`er �\ °' C c 0 �* .
o y°j to
�O� .Zoo.' \`, �t�`''� O z �ZZ SURVEY FOR
�.5y 'p -� c.9: GARY R. & MICHELE D. ENNIS
2,0 P�� ��, ,ryh}e rye ' a o� ATMA TTI TUCK
c.- _________.___ ,. �'L 7 �,. , % �►►� 9 TOWN OF SOUTHOLD
-- � h r: `pc` d� o e SUFFOLK COUNTY, N. Y.
Q X81'1 AN 1000- 141- 02- 09
ST NON ��4 Scale: 1"= 40'�'"-- e Feb. 25, 1993
Q 'Pa...., July 13, 1993 (foundation)
4, a. Aug. 10, 1993(final)
rr
. n 5e0 0� ) 42.59,
�� 5� we^ 1.5` AREA = 30,045 sq.ft.
NI 73�j5'50 HI'
11 6' S. 2, CERTIFIED TO'
AD GARY R. ENNIS
ROMICHELE D. ENNIS
�� r{ U.S.D.A. FARMERS HOME ADMINISTRATION
O. N FIRST AMERICAN TITLE INSURANCE COMPANY
U�`� COPANY OF NEW YORK
630-S-7589-09
II 1L ROAD
•
�t Mfly yAi ere, Z
1-So�
4 MIDDLE .
Prepared In accordance with the minimum /),1 •'%'' S. LIC. NO. 49618
standards for title surveys as established /a , '• dell
by the L.I.A.L.S. and approved and adopted P. sIC 0VEY ', P.C.
for such use by The New York Slate Land (5� • ,'•6 -�5. —A4,
• ELEVATIONS ARE REFERENCED n t TItle Association. P. ` s; ,�.
TO AN ASSUMED DATUM. The locations of wells and cesspools a MAIN r SAW)
shown hereon ore from field observnlions Ja`
' SOUTHO •, 11971
• and or from data obtained from others,
:►3-147