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HomeMy WebLinkAboutJacobson OFFICE OF THE TOWN CLERKO(/�`� ,, Town of Southold Judith T. Terry, Town Clerk !A Town Hall, 53095 Main Road i ''_ ,, P. O. Box 1179 n"I ` Southold, New York 11971 : 0� Telephone $01;14-441/4 (516) 765-1801 ' TOWN OF SOUTHOLD SOUTHOLD -WASTEWATER DISPOSAL DISTRICT J , OPERATION PERMIT SEPTIC TANK or CESSPOOL 'Operation Permit No. 409 Residential x Fee $ 10.00 - Non-Residential Septic Cesspool , x - NAME OF OWNER: Alan C. Jacobson OWNER MAILING ADDRESS: 500 Crown Land Lane ` Cutchogue, New York 11935 OWNER PROPERTY ADDRESS: 500 Crown Land Lane Cutchogue, New York • OWNER TELEPHONE NUMBER: 516-734-7840 TAX MAP NO. : Section 109 Block 2 Lot 12.8 - CROSS STREET: Main Road TYPE OF SYSTEM: Septic Tank New Existing ' Cesspool X NewExisting_ Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: Unknown AkVgi2 MA PilD Af6'cJ s Y s>wT • I �rlit{ T Tarr Southold Town Clerk DATE: August 20, 1987 (TOWN SEAL) • - i - t •• ••. ..OFFICE OF THE TOWN CLERK 'c3�FFO(.,(� Town of Southold '‘ ' ., f-�, COG'- Application No. .0Y. Judith T. Terry, Town Clerk `e T ,-- �C Residential Town Hall, 53095 Main Road � ; -� ��x��_ - P. O. Box 1179 ‘W.1 `_ -0 ,^` �`' Non-Residential Southold, New York 11971 O _. �0 ,� Telephone _ 1 ,.-'� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION - for — -- OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. S. ° Fee $ • DATE / ap11, / '7 ,_..., OWNER NAME: k1g7o 6. . . ,A) OWNER MAILING ADDRESS: r°%' -` `���i' I-6 6 (JOWVJ (1-144-4 (2 .Cic• �/(-c4 6 / / , / `93 5 OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: 7 '" ?WO TAX MAP NO. : Section l6 % Block 2- Lot /02. S' CROSS STREET: 4710/1)14 Catt,4 TYPE OF SYSTEM: Septic Tank New Existing Cesspool - New )( Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: 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.) a/6/1A_ I I �_ Signa r e of Applicant RECEIVED BY• may, �,,� ,�� RE 1V WWClerk' Office DATE: nnn 0 n 1997 southolg • ,,,"4-•"4-- 7;1, I •-t-,t, „,,,,, _ . • •'•,"..'A; SUFF !,-.•,--.•-?,1. _ 1 . , i•-•,-•-tt4" 4.:: '', '- -3 0-ke ----------" 4-- :•,..,,,,,, '4-'4:-- _;•i".. .•"•"4'• -•-•••••,;•.„, . ' •.';'-'..1'_,,,,,id.,'. - - •••KN, ."-- •'-'':".-.4 ...__ ,.. : I ..':•:*:--11,• 1 ...-- . '---,- ... . -- '..c----•- 0 ''''''''' -7,`-‘:-.: -•I -'A ',- , , • -s 1,,,, I / ,AI, i • \ '... \;:. --"5.r'',40 <C\ THE W? -•i-Y•2.54,. • L., N , ',-,‘ 'A - cs, Ci'.-•tr-- -5.\..x / ,-. i ' — °, ..,,----." ,,:cr, 7ZA \A. ,•„,,, ,,\ , SYSTEN '?..5-.0` N. /..„. 46 ,-...,) a • --- ' ::--,,-7,77 1- ,...., ,.... .- ,---. k..C'' '. g,• •\S / •.••••;,. 5„:-" ....44 ••••• -?..„ 4 . 'v. CONFO: .44-±t•.-L, r , _...„. _-_,._ i __, ..,. . - Nc..0 ' , -.- I N t,. -I) -.1- 06 z r .,1,- _ .,;.;J:i . • % ,-1.-.,.- _ ,.. j ., •-..:11,--s.t i '-'-----,,e • - Er2.1-10 --L.- • -:.t.*-1'," r ,. ./i - if CLIUN- ' -' 15• .,„3 ' -",' ,-'•'''.. _ . , ..., -;-:,'; / ,-' \--r .-,- , -,57,3,"? ,I Ar - '7!,i9.-,:,- 111 ' II -4 CO'4.-.;;-/-Pi SUFFOL ,•••••• - . - -.A:•--'' ',....) < / to . i 1 - I8 ' .,••,--'.. ,- t 1 .,.. I . , I ...1 • —,:.fr;::,'-2,- ii CONSTF e ..„......TY.. _Yr,--Z,21,-;?•_ • -5' AV C.) • -0 .7 ri,Li 17 . DATE:_ t , 0 I --- ..--.... ... 1 i ---re c.:). - -_ _____ ..- - -,-:.-„,r: , . H. S. RE -..-„,..,.. ty,.-.. al . . tri 34t ' .----__-. -- ...c...,:??2,;. 1-/ . . ...,,,,,,r.; ' ••. ' COI '71 _ , .'.•-,;,-,' ..;:.7...:4, APPRON, : -:-,,t,-1,;•• - (NI , L... , ... t'f) , ‘ • -- - - ••••:' 4 CD ."'" .., ....,ti:;, ,r-',,,,-;' -- i 1 • __„.-- -- .. -:1:;,75--;.. i zt,,,,;,- , : r,i •- 1 ,------ i .7 . ., i?.... . ....,- .„\-- 1 , i •,,,,... . ;3 ...---- _, _ _ .2''Fg , SUFF , •••,,,..17....-, ,-,V., _.......--r- .,,,, I . 6-72 -Iv -„tt:tt- DIST. 4..... -- - „,„. 0Q 2C v`i" c-- tz, i • ,:,_•-•- ..,- . . -., -1.",..."-- — MAP OF [Di2OPFQTY locc ( ‘ , _ , 4,...., ' 1, ..„ =jr:••,1,t ''-4..;*4,2..-ir,;,=-5•,-.7;:.7,.0-4c-V,0,7;,''';,,,'a!---4i,5.7.8itnP„-4:,,7",.„?-i;.,.,-.,,i,.-.--.,.-.-.l.',' 6 1...I' ; „• ' _e I-\A: .\.,,.' .-,t.:.',. E.- —„i.......,—. \ t ' - OWN ER. ! 1 \ 530 .. ,,,•.4,4,_:„- - .,, .. , ->5- . . _ ----.-- -,.. .-.±s,,i, rA -'- --., ,i• • , ' :--..-„, DEED: 1 ,„ •--. r'''(.1‘...Pt.- ....' , • , .i- — --, .. . •‘rec'q4,* - 17. - r” TEST /WfDP- '•-7-.01' 1-?-1..'01 r.) NI\,/ ' --' - ..." I , 1' :—.1.-- , 4, 7, • tn .. 'Cr' '..,',,A,-. .-• , . . r-'''. •',C,-:.-:. f,-...,.if,. ''_,,t h • • .4*'-•rir`' , '•-iie'-' / .4,/e7,::, ?-_,- — r-, c ,-. t. ,'' r- ,-- LI ,,,,4-,"°.,-zT-,-,--:.,• 1 ------ -,,"I- L.--i- - -- ,...., , • --,• ____ ,,,,, e s. - ... • -.re-., ,-..0....... ...-, • ' "Y 4,,-t•'- ----.---- < 1 „, i••'i i.-)f-7-- I 1,