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JUDITH T.TERRY � �� Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
'yV •r �'�� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS .# \� �1
MARRIAGE OFFICER Fax(516)765-1823 G�r
RECORDS MANAGEMENT OFFICER � Noel 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. 3369-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner HRUZ, PETER F. AND JOANNE M.
Mailing Address 1 27 PHEASANT VALLEY DRIVE
Mailing Address 2
City St Zip CORAM NY 11727-0000
Property Address 1 1145 MEADOW BEACH LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-698-5985
Tax Map No. section 115.00 block 17 lot 17.019
Cross Street NEW SUFFOLK AVENUE
Issue Date: 7/28/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK OF�FFU
Town of Southold , ��� �14:v Application J/o. �
Judith T. Terry, Town Clerk Z` L` $10.00 - Residential/) /0.OZ)
Town Hall, 53095 Main Road a ;
P. O. Box 1179 cn $25.00 - Non-Residential
Southold, New York 11971 O ���'`,
Telephone _°( � ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for • '
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0 , 00
DATE 743/7.�
OWNER NAME: PUTEg- f 4' , P+NIOm- 14 au
OWNER MAILING ADDRESS: :7 Q'rsAT % IetL.Lty Defue
c_00_00A., N- 1. I (-7a7
OWNER PROPERTY ADDRESS: f) VS— 14'1t79bpW 6&) ?W 1-twE
f�A-TT r7UCrc, N- Y. l (55-2
OWNER TELEPHONE NUMBER: oe-s-oes--
TAX MAP NO. : Section / 1 Block f? Lot 1-1, 19
CROSS STREET: I"v e w SvFFOL(e_ ,1iJ
TYPE OF SYSTEM: Septic Tank New ' Existing
Cesspool v New 1Z Existing
Residential V 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:
Town Clerk's Office
DATE:
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SURVEY'FOR JULY 20, 1995 I
1994; PETER F. HRUZ a JOANNE M . HRUZ OCT. 19,
15, 1994 I
LOT NO 25, HARBOR VIEW ATMATTITUCK." SEPT, 9, 1994 I
SEPT.15, 1993
AT MATTITUCK DATE: , JUN 15, 1993
TOWN OF SOUTHOLD SCALE: I"- 50'
SUFFOLK COUNTY, NEW YORK NO. 93- 0432
uv'4..,II,O,"It-0 .1.TM1rAT:Cw ,a ,.02, .0.4 TO Tr,< CERTIFIED TO: — _ ._ __
SUgvE" � A lint,t,`Io+y ni,n- 1r;1,, ;n3 ^s ri.., ? PETER F HRUZ
'"tea s~"'f cF:"'T '"" " JOANNE M HRUZ
" ' ' tfi j-0E" to Tr, "' 4 ""$ T',s 'AMO SUFFOLK COUNTY NATIONAL BANK
T pie I singaZ° >.• hc °. s ,py ( FIRST AMERICAN TITLE INSURANCE
___-- - ---_-___ — 0�uuat.wrEE-t +Na+_flTFD 41: „1A.t.L. UN -oil.T m . COMPANY OF NEWYORK
HEALTH DEPARTMENT-DATA E c}r2 APPPO/ i T? Ser 'PU r "� 'Tilt a-PV>, e0 a€t-70$4 *>•, S.+Rai ,� aRcazyr. i £
ANC ::v YS wE:,dl_•-F io 7,4E ''1LF :'(.WPdL'"; GOVERN-
:I NEAREST WATER 1.104ro, , , , t :1i WATIt R PVNATE___PUBLIC—_ [ MEk7At 9c,Erdf.Y AN4O '_EkC)+s';ti +$9'(•-L'TIOx: I +STI,^
ii SUfF CO TAX MAR Pr': 1000 .4 ,.` , ,1.1..5.§SLOG .17 -Lir' _J719 j H.1' EO, Alyi FL, tfr"*' &SS'z0,,F5 GF 't'F "_F oiDINIrt
+ Tr a -1 I1'I`irt"UTI+Yri r-1" RAN TEES APE FICA' IRA,L4�
3e THEA ARE NO 01dF_LtkaZ WI fi1F 100 FEE. or >$SS R°PENT FEi'ADLE
OTM t THAN THOSE SHOWN HEREON
At OI TIOtt&t :ti57+ I1'I00d5 OR rL'S^, Ct3EN
# THE WATER SiiPPLY AND'SEWAGE DigroCr3AL 3Y2TEI4 FOR r'ri13 In1Cid"ICF: rys,fet:TR S
WILL CONFORR9 TO THE STANDARDS OF THE SCIFi�'C3i,.It COUNTY DEPAPTMENT X-Ui�TRICf S SkOVN H£PEQRd FR°l. f�F,r]NI•pTY LIME'S 1 ,_ g,. ,
TOE',s1r,Pe. v,„ucTt:r`t�S im. ,0f1 A loECiFit: iin✓ U/J��'r..'
OF HE.4LT14 SERVICES ( aUP1POSE ANC Alit. 4OT TO 0£ USE° TO ESTAO:_ISH
A�L.ICAIds/�E/ l'_. /1/21/.1 ( PPiaP£0T,, LtMF v GN FOR ?'NE ERL'c t,to P, X ' M:E'S
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Cep041-r, f II?a-� ` ' 64e 311 ? . l �I w�_ , ``. NG RIVER AD, NEW YORK
NOTE' •-STAKE FOUNDS -MONUMENT FOUND s''`', I AL')EN '4;t YOUNG,°Rf F' r E EF I
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SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF 1 jai - 1 A1,1 LAND SURVEYOR �t YS UCENSF 4C '2'r:45
SUFFOLK CO. ON AUGUST 21,1987 AS FILE NO. 8377 ( µ£
F 1 • H')wAR0 W 'FouNG, LAND SURVEYOR
*THE LOCAT OF WELL(W),SEPTIC TANK(3T)ffiCESS??OOL`S(C )%WiARN MLPEC�Sti [,[... ' N Y S LICENSE NO 4589ARE FF�0M FIELD OSE TIO*S A O OR DATA ONTAI D FRO OTHERSW,S
BRANDIS & SONS INC.