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HomeMy WebLinkAboutHendrickson �OS�FFO`tCO JUDITH T.TERRY �' • Town Hall, 53095 Main Road TOWN CLERK ; y P.O. Box 1179 � riv Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ` ® , Fax(516) 765-1823 MARRIAGE OFFICER =#� RECORDS MANAGEMENT OFFICER - ®.( t► ,d Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER ��,,,,,.• � OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3450-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner HENDRICKSON, ROBERT & MARILYN Mailing Address 1 P. O. BOX 461 Mailing Address 2 City St Zip PECONIC NY 11948-0000 Property Address 1 30145 NORTH ROAD Property Address 2 City St Zip PECONIC NY 11948-0000 Owner Telephone No. 516-734-4018 Tax Map No. section 74.00 block 1 lot 37.002 Cross Street HENRY'S LANE Issue Date: 3/21/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) r�r " „ \ ' OFFICE OF THE TOWN CLERK ' ��FOL-''- Town of Southold �� Application No. Judith T. Terry, Town Clerk % Town Hall, 53095 Main Road y.•G $10.00 - Residential P. O. Box 1179 � ;' $25.00 - Non-Residential Southold, New York 11971 O O �O .$ Telephone _ .( y► (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • -11 DATE . £0'i e4 t�; /77C /-/ INS/ IcKSO /-J OWNER NAME': 9-?frk-C6ca&-azo oC G. -+TAZ,cat-e-c�a----, OWNER MAILING ADDRESS: ��1� -Zel le‘/ -acdr.tcc. /Vy (l c7 S8 OWNER PROPERTY ADDRESS: c1i'f� � ' <71a- e- ivy . I OWNER TELEPHONE NUMBER: 731-/-- 11®f ? TAX MAP NO. : Section 40 7/. .e) a Block ©. 4 tcptcP Lot o 37. 06� CROSS STREET: _ �.._. TYPE OF SYSTEM: Septic Tank %•ice 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 of Applicant • • RECEIVED BY: • ' . 'row Clerk's ' • DATE: . REC EIVVD. ' MAR 1 8 1996 Town Clerk Southold 1 71 /iq e/ x,� /4/67 - o/ ../ SURVEYED FOR:- �o�E� , TOWN OF` O(��/�G+C7 LOCATED ATc�O�//G LOT �aPE / �/ JG CoS ,, 9, l s (� , CO. CLK. NO. MCALE 1" =4.0' /7 i4°1-91 \AP OF . .-E ,e/45E./Di /� N v\ Y SUFFOLK CO. TAX MAP DATA:- I� opo DIST. /DOD , SEC. 0700 ( t�GZ. BLK. 07-00 LOT 01 027000 p" ���• © �' #:- OFFSETS FROM STRUCTURES (-- i'-‘,-(-``. '-'-• \. . \\\ - 4 : -- TO RELATIVE BO!��li?rZ r LIN._ e', ,i ON SURVEY, ARE FOR A %.<. .2-, o- ; lam' pI�°, SPEOFIC us: Oi�dLY, ANO �'�f o�t� SHOULD NOT BE USED FOR �l� o ,I, CONSTRUCTION OF FENCES �""'� ® fF•ff''�� N ssw✓�,v� \ . '. 4 OR OTHER T UCiURFriS. e.0 =i' 73.10 C� / �Ty. �-,e.4 O eei owc.-. N u, 'fes I N'''31111112 2? -1' 111/1.4 N • _ yg o,t P \V z• b 5 �j �oaE2T T v`�/lil.A /cyc� .� I •• � • \ :— '':\7% I- _� 4re� Mo.-T m �iP�T -�.r� ic�'.pvT•jcE ,c/ �y�z� �S, _ - 229./ sl / ��11/L/CE �O/vIj �/Ly O� �� �ISPf� �4� -���� • -aPPox,/ r! ‘',,; ct ...----.. /VbeDDLE A.....-----'0.4.4D CR e7 g-eireria-427 ,, , _..(,..... .,. el:: ,,,, ,,,, FILE NO. /3,.2/9