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Home My WebLink AboutHeins 1, 0111 OFFOUr JUDITH T.TERRY es.1 GyL� Town Hall, 53095 Main Road TOWN CLERK c P.O. Box 1179 �t Southold,New York 11971 ►� REGISTRAR OF VITAL STATISTICS O Fax(516) 765-1823 MARRIAGE OFFICER � �� Telephone (516) 765-1800 RECORDS MANAGEMENT OFFICER : d FREEDOM OF INFORMATION OFFICER /,,i°�� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3641-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner HEINS, RICHARD AND MARILYN Mailing Address 1 P. O. BOX 1254 Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 790 VANSTON ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-2809 Tax Map No. section 104.00 block 12 lot 10.003 Cross Street WUNNEWETA ROAD Issue Date: 5/29/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) w t r OFFICE OF THE TOWN CLERK C3IFOUrr- _ 2 / Town of Southold OHO COG Application No. 6 3 q/ Judith T. Terry, Town Clerk �� .;:.- • , y • Town Hall, 53095 Main Road -{ $10.00 - Residential P. O. Box 1179 Cr3iii $25.00 - Non-Residential Southold, New York 11971 Telephone _ ( * (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE ,y`// ./c: —7 OWNER NAME: g;chet,I.-d 0 & I-r S OWNER MAILING ADDRESS: 120 ge32 cI 5-4 CtirCd-zociti-e, 073 (T- OWNER PROPERTY ADDRESS : 70 Va'el 57;11, eJre_A-7dTJ-e. AIL L 3 5 OWNER TELEPHONE NUMBER: 5-1 (- 7 3 '—f' — J2 °7 TAX MAP NO. : Section t 1-1' Block !2 Lot la, 3 CROSS STREET: Wunn.e,,,i.e�r�,_ oc TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential Non-Residential 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.) Signature oficant 9Applicant RECEIVED BY: Town Clerk's Office DATE: , 1 l. • (;:9�, I iA Ale 0 y 4 n .. bloc k-top I ( v40 \ O. , ' �� !• ' %� ` 1 6- as .gib' y3 /—';‘,,, ali . .." b'\;f1 (I, .. t. '‘`13. f N V 9 d , \ • -•. b . 1 , X\ .eis?..0 0 , . /' MAP OF LAND 5 tIRVEYE0 Fol . . S/GM OND SA R NOWSK/ AT HA3 5, u PO/NT' M WN 47P aourigicGO, l,l. y; Lot- numbers Peter to "ArneriSed Mo,b 50'sI" ,b in zSrt olds cSCd�� % A of rshge.sa►� Dinh,"filed �f I :o4112g , C/srlel office as Ma1b nlo. 158. ;21ei Avforisotertr7`' II Sti'Yef eed Deeettrtber 4, 1974. '+o©r,e of Van 7 '/, P. C. . to this survey Is a vloitl in at ! e. V b.. - Section 7208 of the Now Yak OM F�duestlon Leta _ , Cites of this (S ►1 �' ,. Ole land surveyors tetrad sad ar i '�� ex V Licehsee� Gang' Sur`f�eyor-s Qa '�, embossed and Ad not baattrtefasratl � i .°‘t,*-QQi � 4G -to be a valid aWQapy. `j re�'trpora�, N. Y. ,,co o , '1. , 5,' soarameesIndkxtedhwem+studrt1 i C \IS? , Mgtothe person tor!Atom els swim , i \ 1t`J,i 1 o•p so'cr.cred,endonhisbehalltothe ='� 0 -,9,4 • titer cm;any,governmental agency and ' ``i ,S 256'J4.;lr ten c:I:et utienlistedherssnand �• JPri to tr.::_:.sn:s ct the lending M& tv U tuUo- C:c`a.css are not tretaleebie .. ..., to addr.,o-tut n i�t�tutnons or subsequent • .0,...^"C . _,._ ._.L._____—.....,._....