HomeMy WebLinkAboutHamill li -alfat '
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JUDITH T. TERRY [ Town Hall, 53095 Main Road
TOWN CLERK ® P.O.tai Box 1179
REGISTRAR OF VITAL STATISTICS
�� Southold, New York 11971
MARRIAGE OFFICER '�. Fax (516) 765-1823
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® *®Si* 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. 1966-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HAMILL, GERALDINE
Mailing Address 1 1095 SHORE DRIVE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 1095 SHORE DRIVE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-2063
Tax Map No. section 47.00 block 2 lot 23.000
Cross Street SILVERMERE ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/08/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK -
Town of Southold �� CQG',, Application No..- 1
T:r
Judith T. Terry, Town Clerk .` fix` V
Road Town Hall, 53095 Main -'� $10.00 - Residential
p. O. Box 1179 v' , ` •%:•Z:,•:-` ' ' $25.00 - Non-Residential
11-=Southold, New York 11971 Oelk 1 ���`
Telephone( A\ /
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
• DATE /97.-)
OWNER NAME:
OWNER MAILING ADDRESS: /® 57.6—
//9 -
OWNER PROPERTY ADDRESS: / '/� a���7�-s _' 40671
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OWNER TELEPHONE NUMBER: 77- e=26 3
TAX MAP NO. : Section 4/70 O Block 02-.6 0 Lot O 2- 3, 0 o c�
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New V 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.)
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Signature of Applicant
RECEIVED BY:
Ce-Ton Cl k's Office
DATE: q/ yyq�2
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MEASUREMENTS IN U.S. STANDARD
•
Iliti irfI1IHENSO N SHOWNFOR THE ERECTION-OF THE FTRU TURESS. TO THE PROANY LINE
HERA E FOR ORA SSPECIFIC PURPOSE ONLY.
THEY ARE NOT _
DED
B
CATED
N SHALL RUN
UNAUTHORIZED HS TO HIS ALTERATIONS ORA CONOTIES OF BE RINGHIS SURVEY MAP THE LAND SUR. THE PERSON FORUARANTEES IWHOMFTHE OSURVEY IS PREPAPPF I.AND�\T�I�ITICNS TO THIS SURVEY IS A VEYOR S INKED SEAL OR EM•' ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL
v101 ATION OF SECTION 7209• SUB- BOSSED SEAL SHALL NOT BE AGENCY AND LENDING INSTITUTION LISTED FIFREON,
DIVISION 2 OF THE NEW YORK ED- COIISIDERED TO BE A VALID TRUE AND TO THE ASSIGNEES OF THE LENDING INSTITUTION.
IICATION LAW. COPY. INSTITUTIONS ORTEES ENOT SUBSEQUENT SOWNERS,TO ADDITIONAL .
of. OF NE SECTION l BLOCK DATE ,
M.".1;rc; PLAN _.__—_ .* ,R res
GUARANTEED TO •"").y•, j1
1!�y./1N(�;lilke t 115 ,, �csriyMs�rNN JjrtF /N�. m..y� N y. soCK
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In Presence Of:
0 ENZO//'�PUPILLLO�
C�ih-,-- /!.1y�-���l�l
R SE ANN PUPILLA \
/GERALDINE HAMILL
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