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HomeMy WebLinkAboutHopkins • 40 afro: JUDITH T. TERRYTown Hall, 53095 Main Road TOWN CLERK ® P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER Ve3 N.et Fax (516) 765-1823 �Jj® ® 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. 1941-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner HOPKINS, WILLIAM P. Mailing Address 1 BAUMANN, MARY K. Mailing Address 2 2211 BROADWAY City St Zip NEW YORK NY 10024-0000 Property Address 1 MAIN ROAD Property Address 2 City St Zip ORIENT NY 11944-0000 Owner Telephone No. 212-727-2929 Tax Map No. section 18.00 block 2 lot 21 .000 Cross Street YOUNGS ROAD Date Of Last Pump Out 0/00/00 Issue Date: 7/02/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK •c�VFFQ(,r�'= Town of Southold �� a.. CQG Application No. Vf�/ Judith T. Terry, Town Clerk � Town Hall, 53095 Main. Road c t " $10.00 - Residential ✓� p. O. Box 1179 _ i $25.00 - Non-Residential Southold, New York 11971 • � �O� i , Telephone : j (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION, for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ Io, DO DATE if,130k2_ OWNER NAME: W l LUAI n � ' �'I�P - - Mt1�-� ML)!-1 TIMI 1 OWNER MAILING ADDRESS: 22-11 i-DAD I-V a og-, l ooh OWNER PROPERTY ADDRESS :_-KE" 0.04-1•1-E42--. RAI, 11)+--tT SP-I 1. .6161 OWNER TELEPHONE NUMBER: C2J2- -/272q2-1• TAX MAP NO. :, Section I g Block Z Lot �J r " CROSS STREET: 1401) S ' TYPE`,,OF SYSTEM - SepticTank New Existing V ` Cesspool New Existing Residential / Non-Residential' DATE OF PREVIOUS PUMP-OUT: U,4440104 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.) • ©,rg �- 'i,'j= r- of Applicant RECEIVED BY-: < 5- Town Clerk's Office DATE 1272-40:affiqiiki "ciVasafied:72 cze:(1/41` _1 \\_±........... _____ ..... - ,,,,„,,,,..., . • • . . . . d IlIrial 71.411.013j2t4 si via ,....., ., ..„ ., , i., . • • • , : • . •••• . WELL ••- 1.. . . . ... . • ;. _ , 56 FT.TO HOUSE • - 72 FT.Tb WELL / i •!... 1. • • SEPTIC TANK: /. _ . • (.....4. ,< 100 FT 1 )' ' 1 ., .clah MI-.:,... 4Smeri mill. 1, 1 . f_......... ._ . 17153armr.--. . • •