HomeMy WebLinkAboutHagen •/J 't;
JUDITH T. TERRY ;.3' i; • - Town Hall, 53095 Main Road
TOWN CLERK n " _ P.O. Box 1179
' ►`, `' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICERS
_- Telephone (516) 765-1801
rcy
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1586-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HAGEN, KAREN AND WILLIAM
Mailing Address 1 600 GROVE ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 600 GROVE ROAD
Property Address 2
City St Zip, SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5205
Tax- Map No. section 51 .00 block 6 lot 25.000
Cross Street MILL CREEK DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 1/17/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK .c� FOGL�"-
Town of Southold � ,•.. L� Application No./5f .
Judith T. Terry, Town Clerk • T: �►:
Town Hall, 53095 Main Road :'�
$10.00 - Residential
P. 0. Box 117 9 Era yK z�,.
,,.. .r �--t -��` �• $25.00 - Non-Residential
Southold, New York 11971 O `®_ ....t."�0�,•�`
Telephone `N�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ i0#00
DATE // 2-7qo
OWNER NAME: Wi'J// � figjeiti
OWNER MAILING ADDRESS:6W a- 1
No 7 ,/tl° 4/147/
OWNER PROPERTY ADDRESS: :56yr-4Z,,
OWNER TELEPHONE NUMBER: 1 6 j — 5 2 o5
TAX MAP NO. : Section 5 / Block 67 Lot
CROSS STREET: di (t't eJ /) /'ve
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: OC�, /1) /67q0
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.)
1"./dA.414. . (V)
Signatur oft pplicant
RECEIVED BY: - -r*,,� %,
Town Clerk's Office
REcc 1ki
DATE:
,ov d '
j 1910,
TOM S®utho➢t
. . .
.............___
-- ;
• .
i
. . .
I .
..
t
I MAP OF PROPEQTY •
. •
NIF PRAM4 '
tv
.. i. 51.11WEY E.V Pio cz. _ ?
WILLIAM 12..d.VA12EN _1/41 1-1AGEN
. N.57°-' ,5e0owe; 00.00 I AT 1
r .
ARSI-IA MOMAQuE
- • 0 t
.._• • 2 trl
1,4 (44 1 TOWN,OF SOU 1-1-4 OLD my
3
117AKEL n
•., 1
zi ; I pi
.i .
‘,.
,......,...i.....1 -. . . ,
8
PARC-EX Z. • .- , . "..i.1:7/211411,
' WintribNe
• J r ,,.',.J Ski.:1 - '-'°
i •
1
% 0
I . =
• ,.......„ ,ii . ...
. . .. .. . ..,,,..... ,, „,
91 I
.1::
-- ::'111:':(1-1:1;:rt:.6:1:1:7'1::::::Irl'a':.e:h9/
g 1
o LI
4* g 0
1 36. 01
—1,.. .:' • , , ,....:
- •
. (.6
. , , . • - . , ,
1
S•5 °%'•
o0"WO.1... - 100•01C1 / . \
.. • \•
, jh 1 •. . .
(ti
I. • ; ,
t •
•\ • )
..,, ..
N:s: •,/ ,"V_ /
•, ,
•• '.: :•, ',
•
c IV F •
.Ckr-KA
. -- 50,
—.I
,..,, ...,..b ...:.
•
,
. zEuF
.. . . ,. .
•
.•
GUARANTEED:1D 5E.CUIZI TY TITLE I C4JARANTY CO
. .
• • SOUTHOLD SAVI Nr,v5 f:SANK
• •• . . • , ,
• , A•5 SURVEYED .....
. ._ .AuG,8t1989
., •
20DEIZIOCWI-
•
TUVL
.-12.... ....,.. . ..„......,.../., .•
QS• .
N ;
. . . .
. . ,
1 r . , '-0't 1 vr;ta •pip:e...i.i;-
• Z •V ekpao— I No.A042
-i , AREA.' , ".',IT ...,•••• -
. •
a
I-ICEN5 r• E:) LAND StuRVEytDri$
.BIDEF. 3 ,TMCMAP..1,16.TAI 1000-51-G 25. GRE Est PO CZ,T N.y .I
..._. .