HomeMy WebLinkAboutHansen (2) JUDITH T. TERRY S° : Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS : ® Southold, New York 11971
MARRIAGE OFFICER" � Fax (516) 765-1823
®z �i+1 Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1711-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner HANSEN, MELVIN
Mailing Address 1 P. O. BOX 130 -
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 445 ORIOLE DRIVE
Property Address 2 (H I GHPOI NT MEADOWS LOT #25)
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 55.00 block 6 lot 15.028
Cross Street LISA DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 6/27/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �U�FOL16
Towrti of Southold Y �Q �„• -1 Application No. /-2//
Judith Terry, Town`Clerks Y
' kt4t $10.00 - Residential
Town Hall, 53095 Main Road :47e
P. O. Box 1179 u-3 ;s:`:> a $25.00 - Non-Residential
Southold, New York 11971 Q _® �`�i'�,,
Telephone 0•�� ��
(516) 765-1801
TOWN OF SOUTHOLD -
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
•
DATE - al 9
- OWNER NAME: f'1 E L U / , ) 'J : •
OWNER MAILING ADDRESS: p. 0 • i3 a X 13
---Soo • v f 15
OWNER PROPERTY ADDRESS: q its- 0 < 0 c. E �2 / —So U T7-Id c. .v
L o 7 L5 1-//CH •.) 2- 11 et.) s
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section5 S Block g Lot A.5-. 2-8
CROSS STREET: L IsR N 1 U &
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New X Existing
Residential X 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.)
(e0),X1
Signature of Applicant
•
RECEIVED BY:
Town Clerk's Office
DATE:
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SURVEY FOR
SUFFOLK COUNTY DEeARTMENT OF HEALTH SERVICES MELVIN HANSEN a JANICE HANSEN JUN 4 1991
DATE'u" t�tNU I4 'H.S REF.NOG 9l—H )—/'• AT ONLY TNO SOUTHOLDGHPOINT MEADOWS,SECTION TWO" APR 9,1991 ,
DATE AAUG-15',19991
I The sewage disposal and water supply facilities for this TOWN OF SOUTHOLD SCALE I 40'
I 1L1CatlonhavebsenlnspectedbythlsDepartmentand/ar SUFFOLK COUNTY, NEW YORK NO 90-0610
I, other' 1 and and. epatls�gory.
tt//�� l ! • ■WYUTHORI[CD ALT[NATIOM ON ADDITION TO THIS GUARANTE E t (
SURVEY O A VIOLATION OF SECTION TAOO OF THE MELVi, 84 1 vE
Chief f Bureau of Y.astewater Management r NEW roRR!TATE EDUCATION L•• 4 _ w
HI CONES OF THIS SURVEY MOT SEARMG THE LAND JAN I's
SUSAN TONS INKED SEAL DR EMDossED SEAL SHALL SU' OL IJITW.N IBANK
MOT SE CONSIDERED TO BE A VALID TRUE COPY T OR -E G ARM E C,MPANY
RGOARANTEEI INDICATED HEREON SHALL RUM OILY 10 `i 1
HEALTH DEPARTMENT-DATA FOR APPROI#L TO CONSTRUCT
THE PERSON FOR rllor THE TITLE
IS PREPARED ti OMT' EjTI. •}}f--10$)
AMD OI HIS BEHALF TO THE TITLE COIPANT,Gomm- - -1+Z Q !
•333333 WATER MAIN_,II _ ■SOURCE OF WATER PRIWITE_PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED `rJ
I fA/F CO TAX NAP 01ST 1002 SECTION}3_ALDER Ji—LOT NJSI HEREON,AND TO THE ASSIGNEES OF THE LENDING 1t,a 1
•THERE ARE PO DWELLING! WITHIN 100 FEET OF TMS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE `..
OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
■THE WATER SUPPLY Alp SEWAGE DISPOSAL SYSTEM FOR THIS NESIOENCC OWNERS ( Hy'0 i 3 I
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEAART•[MT
*DISTANCES SHOWN HEREON FROM PROPERTY LINES
�� Q •� y
OF NEALTM SERVICES TOIRISTIN6 STRUCTURES ARE FOR •SPECIFIC VA I
APPLICANT. PURPOSE AND ARE NOT TO NE USED TO ESTABLISH f�HAND SU
PROPERTY LINES ON FOR THE ERECTION OF FENCES '
ADDRESS _
TEL YOUNG a YOUNG 400OIEADNNEW AVENUE
NOTE S MONUMENT _ t
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF ALDEN W YOUNG,PROFESSIONAL ENGINEER
SUFFOLK COUNTY ON MAR 19,1990 AS FILE NO.8911 AND LAND SURVEYOR N YS LICENSE NO 12845 '
HOWARD W YOUNG, LAND SURVEYOR
2 •TOW LOUTT0710 WRLIWI,SEPTIC TANRISTIQ CESSPOOLS(CF)MOWN Wilco, NY S LICENSE NO 45893
m ARE PROM FIELD°pEWMTIONS AND OR DATA OBTAINED FROM
7.S
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BRAMDIS L SONS INC