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JUDITH T. TERRYTown Hall, 53095 Main Road
TOWN CLERK : v P.O.P.O. Box 1179
z.
tl' ' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = Vo �� Fax (516) 765-1823
MARRIAGE OFFICER '---sj'/� a�O of
,1' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER O,l
FREEDOM OF INFORMATION OFFICERi011- ��.°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3156-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HORTON, STEWART AND FLORENCE
Mailing Address 1 P. O. BOX 27
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-1220
Tax Map No. section 17.00 block 4 lot 10.000
Cross Street OYSTERPOND LANE
Issue Date: 12/20/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i
•
OFFICE OF THE TOWN CLERK c,VFFO(,r �
Town of Southold CQG' Application No:---3/ --
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road I $10.00 - Residential
P. O. Box 1179 trs . fr `= =x€= z $25.00 - Non-Residential
Southold, New York 11971 O "'' r^ */
Telephone =�( Y►� '��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /&-C
Fee $ l Q D c.)
DATE pe , - J( / 73
OWNER NAME: 5 �i /' e G /�
OWNER MAILING ADDRESS: ?(" • &9K GP? 44sr RO4d
jc,y Mew rO r 111 %6-7
OWNER PROPER) Y ADDRESS:
As- 4be,v
OWNER TELEPHONE NUMBER: Sy6 — ?� --J 0
TAX MAP NO. : Section / 7 Block 4.71 Lot ),�
CROSS STREET: 0 cts'''171-e,i/ fluid
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ew Existing V
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:" / CW?"
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.)
: I rrJ /
Sig ature Ap.ricant
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RECEIVED BY: ,6t.4111,11 -
Town 'er 's Office
DATE:
/ t
i
Iy,t
una1rezdead alteration or adducer
Mac K b tJ i to this survey le a violation of -
1 Section 7208 of the New York Man '
s Education Law '-`
5.79'29'30"E. - 108.93 +
Copies of this survey map not burlap
_.- --'--- _ -- the land surveyors inked seal or
si'o tt a era{l embossed seat shall not be considered
m a valid trw copy. .
1\
Indicated hereon shall run
to the person!or whom the survey •
prepared,and on his behalf to the '
company,f...:-.In-anent!agency sal
institu•k:..steel hereon and
the assignee::LI the lending bud-
+ Guarantees are not transfii s
0 o additional institutions or subaqua* :
°' " i MAP OF Pi OPEf2TY
a 1 in _ V. SURVEYED FOR
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STEWAR-T FLoR.ENcE 1-1o2T01•1
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( N• 63 • Tifile_ Insurance co. add fio fou hotel Sdvi, .
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81�0�4y. fed C- SanK _aa serve ed . _.lune S, 1967,
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Licensed Land Su • - ::,
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