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HomeMy WebLinkAboutHeath ,oc��FF OLKc®Gy JUDITH T. TERRY ; Z : Town Hall, 53095 Main Road TOWN CLERK p T • P.O. Box 1179 REGISTRAR OF VITAL STATISTICS U'®� �� Southold, New York 11971 �� MARRIAGE OFFICER ®� • y Fax (516) 765-1823 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. 2086-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New X Existing Name Of Owner HEATH, ORA AND ELLIOT BRUCE Mailing Address 1 1523 MADISON AVNEUE Mailing Address 2 City St Zip WEST ISLIP NY 11795-0000 Property Address 1 500 HIPPODROME DRIVE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-661-8767 Tax Map No. section 66.00 block 2 lot 13.000 Cross Street ARSHAMOMAQUE AVENUE Date Of Last Pump Out 0/00/00 Issue Date: 3/25/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) , OFFICE OF THE TOWN CLERK 'r.OFDC,��'• Town of Southold % CQG; Application No. .26 IC Judith T. Terry, Town Clerk ' 4 i, Town Hall, 53095 Main Road ,, t.„-r1 „.,- �- 1 $10.00 - Residential c p. O. Box 1179 ' ,���f � Er) % $25.00 - Non-Residential Southold, New York 11971 N.,:1,' ^ t.,- Telephone #40./4447-.. l • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL • Operation Permit No. Fee $ IO; 0 DATE 1 i OWNER NAME: ir / It e i7 g/,hc, �t/Gfr'7--/ OWNER MAILING ADDRESS"dify1l‘ , A` i�/ems . �c t/a /l7'C OWNER PROPERTY ADDRESS:- - 4332 (44,47- .401‘6- 4, - - .5.,„7-i-k-ez) OWNER TELEPHONE NUMBER: 4 h ' C7 ,• TAX MAP NO. : Section 0[a Block 2-- Lot 8 (if 2-l?J CROSS STREET: f4 4/14•26—.-- A, , TYPE OFDSYSTEM: Septic Tank l ew 1/ Existing • ,� Cesspool V/41.3 New %/ /Existing �� , Residential X on- esidential DATE OF PREVIOUS PUMP-OUT: 3 ' LOCATION MAP: Must be attached hereto before permit may be issued. (Locate building and system; give north arrow and feet of distance, approximately, to b, ding . -d closest road.) eogr Adr . ;Ire of Applicant , . _ _ _67/-7-,44J-g3 -A.ays/Afrie.r5 RECEIVED BY: jA.),(•-446--4-=--- -• Town Clerk's Office 2 6 _ DATE: 3 - THIe No S-6S3t9: i L o71' 6 4 y1 Ai. 60.AZ?'4-©^'g- . \'a \ 9 ' .o - ___ . - ' C211 1 ± W 'J"f 5a°arm , Q • Lei- -L C , \ V,:.e... ./-,4-1 N'• k. '� ' -,�. O ti] .. 1p. q",or',I fir. ..5 ..S V`L9 l +_•t� 1�3t/�RC i_, 1 trya Copy�K u3�c ;4.., ...-.<:;,:,,, ,,:.52"% 1. '�` �,rrl It + i..r[r+! e ,„ /.1°.''''''', 1�� 3 i Sttr .. e' 4�E£ hjytr _--ad to J Derpon h a. . Q eto °'' ..: `` ` `� -moi'- ` `. s_, —.y` A dtp.• ''S' <.::,_ 't.\\)* \.-`.\ \ •-.7V: ' N • ,, '.. S• e.0off_ 4C • (,/_7_,./60.5..e)-------7 _., z1 'L rk 1-//,' CRo/1,-t7/R./v� (vi- r r ) ,s-cak ,40 /,w/,/ U At rrIonz,/ re,r 4 O s 71 Arca- leo Q �� �,•t� _-_- - _ to 1992 A/1.41:7 co,=-- Px Q -/::Z7-r- UPz v.E' -E C? FOF-z # EL..L.I JY 'J .r -1 . 7" - M. eevised Jury 8, (992 show coH +s. �i C:h: l�'�an C�tt'tk-�t1r�( 1� urrc:rrY ►1 sea level. N.G.V.D. s [1 T,E-{C.�c` .1,4)--#4;',c, vgti t; cam-Ct.LP tYt} 7 - *cc-7t.,�ar:1t"l1 r..a, Se : Lo-74 t ,rrrb�e�r+ stic9 f�rr f-�° �r ��g .e { �. a5 sic 'd/ti'�t C'3'r j eJaC E'. 7/2:;'7�e" 9 i ,t {2�'L 1c:..i - ' i '7.0`.7 ,PC2. Block I . P.. ICITI f� �e ... 1.,141.46/k, Ccw y ,2 �, � ' �o�,a,l, � ti iL. �'-jar_. f 1/c-er as A.41-90 A . /4-7'2 . _ t.. ,. fk: Coar 7txx Mtx ` 5ec OC- ' •