HomeMy WebLinkAboutKeith ',`i1 ��fEiU'1
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ar 'F ;' Town Hall, 53095 Main Road
k W® ;• P.O. Box 1179
= ��®� ��®�i!� Southold, New York 11971
JUDITH T.TERRY = 101 FAX(516)765-1823
TOWN CLERK
�'%������ TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1334-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner KEITH, ROBERT AND HELEN
Mailing Address 1 995 WILLIS CREEK DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 995 WILLIS CREEK DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8508
Tax Map No. section 123.00 block 10 lot 2.000
Cross Street NEW SUFFOLK AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 12/06/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �VF� �'
Town of Southold ® -,. CQ ' Application No.
Judith T. Terry, Town Clerk � Kau.
Town Hall, 53095 Main Road ,,:'� Residential
P. 0. Box 1179 u' '� : Imo' ; Non-Residential
Southold, New York 11971 O ® rO�'•°�
Telephone - __. _ �1 1%
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ►
Pew..•. ; 4--j P,
Fee $ 10.00 ..(/ oz,4 -t-c ``" 4
DATE //la/A?
OWNER NAME: ,e6) erJ- ard )Je e1L 4'e-/
OWNER MAILING ADDRESS: 99s- it);111.3 Cr-exi 'rj
r kkack iu y I 191--.Q
OWNER PROPERTY ADDRESS: C 1S 1,0, INS Creek r�ve_
OWNER TELEPHONE NUMBER:— 5e)g
TAX MAP NO. : Section tai Block iD Lot a
CROSS STREET: Neu.) Su- Iy. u e.
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.)
Si�ure o is nt
eta-%ye t
RECEIVED BY:
Town Clerk's Office
DATE:
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APPROX.IE ALONGH.W. /93.82`
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DEEP HOLE CREEK or WIL L/S CREEK
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,/ NOV. 11989
SURVEY FOR MAR. 28, 989
ROBERT W. KEITH & HELEN W. KEITH JAN. 30,1989
SEPT.23,1988
LOT NO. 16 "HARBOR VIEW AT MATTITUCKit u E 207',19 8
AT MATTITUCK DATE DEC. 23, 1987
- - TOWN OF SOUTHOLD '10,....,,-_, - SCALE: I"=50' ..
- SUFFOLK COUNTY, NEW YORK NO. 87-1480 .
*UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANTEED TO: f
SURVEY IS A VIOLATION OF SECTION 7209 OF THE ROBERT W. KEITH 8 HELEN W. KEITH
NEW YORK STATE EDUCATION LAW CENTURY ABSTRACT CORPORATION
*COPIES OF THIS SURVEY NOT BEARING THE LAND CHICAGO TITLE - ' -CE COMPANY
SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL
NOT BE CONSIDERED TO BE A VALID TRUE COPY '(E OF /y
*GUARANTEES INDICATED HEREON SHALL RUN ONLY TO - S'(Pe F�,
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED-
AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- �pIaD I�r `Q ti
*NEAREST WATER BAIN_MI _ *SOURCE OF WATER. PRI' TE_PUBLIC.L MENTAL AGENCY AND LENDING INSTITUTION LISTED 0
If SUFF CO. TAX MAP DIST LQQ9_SECTION 123 BLOCK Jam.LOT 2 HEREON,AND TO THE ASSIGNEES OF THE LENDING 4 Z 1 '. 0
*THERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE :;� _
OTHER THAN THOSE SHOWN HEREON.
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
N THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE OWNERS if
*DISTANCES SHOWN HEREON FROM PROPERTY UNES _; 33
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES ARE FOR A SPECIFIC ' -i—
OF LEAL�fTT SERVICES. PURPOSE AND ARE NOT TO BE USED TO ESTABLISH
APP •
PROPERTY LINES OR FOR THE ERECTION OF FENCES �(+F, • 4589
ADDRESS {+`rt,n gig, ' • EA011
TEL YOUNG a YOUNG AVENUE
RIVERHEAD, NEW YORK
NOTE: I =MONUMENT
SUBDIVISION MAP FILED IN THE OFFICE OF THE ALDEN W.YOUNG,PROFESSIONAL ENGINEER
CLERK OF SUFFOLK COUNTY ON AUG.2I,I98T AND LAND SURVEYOR N.Y.S.UCENSE NO.12845
AS FILE NO 8377. HOWARD W.YOUNG, LAND SURVEYOR
*THE LOCATION OF WO.L(W),SEPTIC TANK(ST1f&CESSPOOLS(Cr)SHOWN HEREON N.Y.S.LICENSE NO.45893
ARE FROM FIELD OSSERIMTIONS ANO OR DATA OBTAINED FROM OTHERS WS
BRANDIS & SONS INC.