HomeMy WebLinkAboutHale Y
O Town Hall, 53095 Main Road
JUDITH T. TERRY
Z • P.O. Box 1179
TOWN CLERK : v Southold, New York 11971
REGISTRAR OF VITAL STATISTICS tinFax (516) 765-1823
MARRIAGE OFFICER _
Ts*, 7�� 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. 1796-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HALE, PAUL & ADELAIDE
Mailing Address 1 BOX 339
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 5132 NORTH ROAD TO BAYV I EW
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1971
Tax Map No. section 79.00 block 2 lot 6.000
Cross Street SHIPS DRIVE
Date Of Last Pump Out 0/00/85
Issue Date: 10/31/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK •�\FFQ 4
Town of Southold &N) CQG•_, Application No. /7 ?4
Judith T. Terry, Town Clerk _
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 crskh�i $25.00 - Non-Residential
Southold, New York 11971
Telephone ( '1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10,00
DATE 0i_ •�
OWNER NAME: - ! 6 at.
OWNER MAILING ADDRESS: I 339
•
Ot tn00L liq7 I
"
OWNER �.�PROPERTY ADDRESS: I a .,'� igen ',:�' �
OWNER TELEPHONE NUMBER: /6) , CI 71
TAX MAP NO. : Section q I Block a Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
lt
Cesspool New Existing V
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: I 1 (,a)
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.)
S ,477*'C!ems .Su 2 V •
Signature of Applicant
/�
g pp
RECEIVED BY:
Town Clerk's Office
DATE:
5ccx1e : f-70‘-.7... l"
M44(- ' o� jQoPQY(
D = �•Torc�rttetT-i-
SUG_V� .F..0 C3
PUL L .L. L_._21 C t i'. , --i�' ) . _,- �--
ar
E34W(E 1fV �.,� $cf j l� J,r trs T�cx Mc4. C icer rafivr,:
--, '- ---, - TOWN SoUTNCL: N.Y- -� Oi -. 10005ec--f. 0-79, elk. 2, Pal. r _ .
I
Co'ufiI 4e 2TY I t
I
T
PI •
N • fbtJGHE2TY I �AG�t�I
5.68467'50"E. 375.0 ; f 11 I ;
„_ ,
cont.bldg. 1111 ØfrtbL e !i s
-
• CJ - ~ • - N.68`3?'5O"W. � 3O?.9O
7. d "
,4 _--Z - _ W
ea \L ` / mr
`Y
f
° i o
Q I ;• t , ,: i . r f - 9,
1�
I. p 36 a. 303.23 `- •_ _e ��res
i G i r•?�b \ Z_
�. 1 "'" 1110.'0. ` `� K} �r' �'�D=-—- `' - 1-r d ve l e d e ar r--11-Fi r# grave l ci r i v C ----T;'%<‘--
.. /,,,,7'e.
.r I M
[ '''.Cl&I '''''..,,,.. t: '')42 c.e4.-::>3
%J7
...•truer x--i s
pen couGl-iffeTY
--.......,..
(� N , ...,
‘. 0 t
0 %1„ CT
cE
0 1
'J
�� eaI • i
1.250
I�E'tt' ijQd ,I11
4. , eiNAUTHORIUD ALTERATION OR ADDITIOIa t
_ TO THIS SURVEY ISA VIOLATION OF Tr-i-le 1V0. 1282 008'`T7
{ - . ` SECTION 7209 OF THE NEW YORK STATE
G'a EDUPATK)N LAW.
qo•o N.68'9?"50"W. - 235.0>� M. - - I , ,
�j+� COPIES OF THIS SURVEY MAP NOT REARM?
THE LAND SURVEYOR'S INKED SEAL OR • Cuarpe Thee lo P
EMBOSSED SEAL SHALL NOT r CONEIDERRD
l' ! -
i IO RE A VALID TRUE COPY.
, . 1,t .
GUARANTEES INDICATED HEREON SHALL RUN The Ti-Heee CottOm-uj J
as SLOVe gd,may 2f, 982• .' `�� 1` I t'
iI ONLY TO THE PERSON FOR WHOM THE SURVEY J '
• '1 IS PREPARED,AND ON HIS BEHALF TO TME y���...,..� ^A t'` . - /t I ' Y
J�, 7r r�i�R t 7 TmE COMPANY,GOVERNMENTAL AC11401 AND 1 ICK VII 7N�1 0 6\11.,RSC...
Q LENDING INSTITUTION LISTED HlRRON,AND .
w I 1
„4.1 j 4 TO THE ASSIGNEES OF THE LEMING WTI- Z. /Mr!'�"� �•�•�•�'F [J
TUTION.GUARANTEES ARE NOT TRANIFRRABLE
TO ADDIflOWLL 1RL5iflU'I10NL OR AIOBEOUENLicei•Is l La SS r `e r5 -
- -wNERS; E- reett :.. • New J b#k . J
x ' - 1
'�- _ ' - I
1