HomeMy WebLinkAboutHewitt c
Town Hall, 53095 Main Road
�® ,' P.O. Box 1179
__. � ; � ��� Southold, New York 11971
JUDITH T.TERRY - ii ,,•0' TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 742-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HEWITT, DAVID W.
Mailing Address 1 245 LONG CREEK DRIVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 245 LONG CREEK DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3599
Tax Map No. section 55.00 block 3 lot 23 . 000
Cross Street TUTHILL ROAD
Date Of Last Pump Out 0/00/84
Issue Date: 6/24/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
. ,,-
QFFICE OF THE TOWN CLERK �CU�FO(;r _
!i. Town of Southold ACQ Application No. '744=7
Judith T. Terry, Town Clerk
Town Hall, 53095 Main RoadResidential
P. O. Box 1179 C.11 �' Non-Residential
fir, ti .{ .
Southold, New York 11971 O*0/;-.11c, x , ���`�
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /cP a0
DATE
OWNER NAME: ,AQP(/;o . ) ,`
OWNER MAILING ADDRESS: ,(dn 4009 &eg-eekJrs`J�
Se" x" P //9
OWNER PROPERTY ADDRESS: Se2p/3-e
OWNER TELEPHONE NUMBER: 6./6✓ 30-9?
TAX MAP NO. : Section L-67-5- Block 3 Lot a. 3
CROSS STREET: /6(
TYPE OF SYSTEM: Septic •Tank New Existing X
Cesspool New ' Existing
Residential X Non-Residential
7 -LOCDATE OF PREVIOUS PUMP-OUT: 47 -
LOCATION
ATION 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.)
c� ) ���
/Signature of Applicant
RECEIVED BY:
Town Clerk's Offide
-- MORD
DATE:
JUN 24 EN
Tom Clerk Scold
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Loi' /1 I/1t.,bat-:.; refer I'd _ - MAP of PI (.)PERTY -- -
•� : «. el,s ,ria,/ ;/4. Slal DAVID W. MARY M. NEW/7-7-
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7o1i77W OLD, M Y
, UNAUTHORIZED ALTERATION OR ADDITIOTi• 1./:_c Q 6• 40 it
si
TO THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF THE NEW YORK STATE 6UAecti1 freed y 1 0 Api rhe/cols rifle a =IVOtglit r111'
EDUCATION LAW.
COPIES OF THIS SURVEY MAP NOT BEARING i't1$afiat/C! co. and 4 oti/'.4 d d-dQ'vrt:95 --
THE LAND SURVEYOR'S IN;C_D SEAL OR �7 �-^ t .
EMBOSSED SEAL SHALL NOT BE CONSIDERED earig- A•d otirveyed Felo.•�t_' S, 1975, �
TO BE A VALID TRUE COPY i
GUARANTEES INDICATED It[P,roN SHALL RUN TGo de rick Van 721y4 P. C.
ONLY TO THE'ETSON FOR WHOM THE SURVEY
IS PREPARED, AND ON HIS E:IIALF TO THE • �4�s I
TITLE COMPANY,GOVLRI:VEN.AL AGENCY AND `' ` _.'J-. "J_.�- i
LENDING INSTITUTION LISTED H.REON,AND, -
! TO THE ASSIGNEES OF THE LENDING INSTI• ' r t '
' TUTION.GUAPAHTEES AIM NOT TRANSFERABLE L ice%•r a e'd .400:1'•:0 See 9 .1c
TO ADO1110NAL INSTETUDONS OR SUBSEQUENT Greet/port, 4V- Y. i
OWNERS.