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HomeMy WebLinkAboutJeng Ie# ®sUFF04 • o c® JUDITH T.TERRY �,0�� 14: Town Hall, 53095 Main Road TOWN CLERK ; ; P.O. Box 1179 d. n� Southold,New York 11971 REGISTRAR OF VITAL STATISTICS V MARRIAGE OFFICER `� � ®)�'.11 Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER ®.( +01.1Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER ,,sty OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3607-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner JENG, GEORGE Mailing Address 1 105-25 67TH ROAD #2F Mailing Address 2 City St Zip FOREST HILLS NY 11375-0000 Property Address 1 240 WATERVIEW DRIVE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 718-520-8387 Tax Map No. section 78.00 block 7 lot 31 .000 Cross Street MAIN BAYVIEW ROAD Issue Date: 4/11/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) • • o . ,„.OF THE TOWN CLERK %IRV(C-_ 3 a I Town of Southold �� QG •Application No. Judith T. Terry, Town Clerk • y Town Hall, 53095 Main Road j -' $10.00 - Residential P. O. Box 1179 ul K . % ° - tri ;' $25.00 - Non-Residential Southold, New York 11971 Telephone -°70jiwr (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE 4--?—?7 OWNER NAME: '6.75;jQt6 OWNER MAILING ADDRESS: /©� 2 67429 V z� 7 1-0/66S ivy /,1--3 7S-- OWNER PROPERTY ADDRESS: '24o aT Ui J 5oi'7 j AP/1/ 97/ OWNER TELEPHONE NUMBER: '7/.d5 -50 - 83$7 TAX MAP NO. : Section 76:2 Block 7 Lot 3/ CROSS STREET: Ni/.! /,-_ Q,9-g/(/16c TYPE OFSYSTEM: `Septic'=Tank--.`--_ --_'.' ____.New Existing Cesspool New Existing , Residential_ Non-Residential i , 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 �(ld. Toini Office - _..__. APR 11 1997 - Southold T'+l Clerk t 3 • S 59'01"00" E 225 00' 7E vk1 0 1 - �I i r- 19.30' --1/ I1900' J II EXIST. 1\ !v I CESSPOOLS\ EXIST I STORY I u ui, j+ 1_____ FRAME DWELLING I 2186"± \--.1—i 16 00" \V/CELLAR REPUTED LOCATION FOR EXIST. 2"0 WELL 1 N1 + I 1 EXIST STORAGE 1 w i:-. 1 � � 1 2 ad _} zI _ _ F2 N 59'01'00" W 210.00' Q 1 _W I } 1 0 Lu 0 I � 0 g 1 MAIN SAYVIEW ROAD