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HomeMy WebLinkAboutKillip JUDITH T.TERRY 11 9'( eo� Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER � . ® of Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER ®� ',� Id� 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. 3719-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner KILLIP, THOMAS Mailing Address 1 2500 JOHNSON AVENUE #4G Mailing Address 2 City St Zip BRONX NY 10462-0000 Property Address 1 1750 BROADWATERS ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 718-601-0487 Tax Map No. section 104.00 block 9 lot 9.000 Cross Street Issue Date: 11/12/97 - Judith T. Terry Southold Town Clerk (TOWN SEAL) �. V.. OFFICE OF THE TOWN CLERK c�VFFOC,��'- Town of Southold , 0b� CQG<:\ Application No.3✓ 1� Judith T. Terry, Town Clerk . Z Town Hall, 53095 Main Road �i - ) $10.00 - Residential P. O. Box 1179 u' _ $25.00 - Non-Residential Southold, New York 11971 O �e�� Telephone Q( * `tZI (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION - - -- - for - - - - - - - • OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE / ° 1aco /g> • OWNER NAME: '11((i t iV4' 1(co OWNER MAILING ADDRESS: 2-C6C) :117V 1iit xi 4 &- / - ‘gncr c l 0`f(c2 OWNER PROPERTY ADDRESS: (7�t) VI^uck4 )u $ P-4 OWNER TELEPHONE NUMBER: 7Lg (00 ( TAX MAP NO. : Section '/O Block 9 Lot CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing [/ Cesspool - New Existing Residential 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 Applic6nt RECEIVED BY: �:�� erk's Office DATE: N 0V 12 199T Southold Town Clerk ieloe.7ei..•Zane A 4 ---F'laa ZAPne c • '25$ 4 t+q,+ �tr�''t��rT 6. 4$ ' 4,5"I t 0 ,1"s`~. 5'1:4. O w , .. .. .. ` firy t. I*.o.-aloor,(4*-a , L__ . ..,. ...._, ' ;_,_ ,a " a t t ,.% , 5 r 1 II t '''. 1. V\#.:4' is r.!i es v.. 19.I ,, 6.\ \ , .,... ‘s.,, .-.3400. ) ' ' ,, , ,... .. ..e\s„dr‘ . lel 1. 0 j': ?ft,41,'• ' iM1. N ' O r , 46. i e. c -Nr- 'IC c( (21" p gab ; . s s-nd alteration or addition k.--- •-+ey Iso violation of v209 of the Now Yost tete \ n haw. a,htasurvey„ept - •r_. __ _. P�Q - _----- T Y surveyole Inkeda� sd seal shalt not be oonskised � 1�° �' "� .�'C1 fd. valid true copy. teas Indicated'hereon �, { }/� per," f L/��d it f �sf2 Bell/L',4- the person far tlltl,arr► e ��`, • '" '+.w/ !„f.f 4� � •' DIANA 4` . I +.. f L 8 ` .• sred,end an his behalf to th mv.mgovernmEm xl agenoY atrt :ti 'institution listed hereonn , assignees of the lending �9 l' c Guarantees ere not transferable +� � ,gonad institutionsor=be+gwn —HA.6 j til+V PrO I Air " op NEW G. y�7 8�d , ' 4 a. ...__,....--. �� t< V-- rQ -'Maw G®_ off ad G v,p Cu rclirc> `t''4. , . V. �..(-0L, �,�c „ * ii r ®L.0G P /coo ro4-9-� ' Y:�. ? /0ot3, 1:tic . hiU. E3 4$" 404219. BG'�+i ' % b'Q;= 111 ��, 1. S°Z�6ti�, Imo-. �.� +`liitit 64r.S -yea,'4 r* 1-0 •�Arr18tYcfed Alai; ...6..,„ c,..3 �' ::G✓r9e3 e °•t aL'RseIa P+,Jt?t 7 f ts4 di AT et-4,64'011r 4'011r CPR/a7iAr Ca r'4'e 1117c✓ ,-de',5 eV,1"4 C 0 and ? ?id. 1 -- - - - __ ..-- ____ i it ` i,•- . 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(w''- 777. tine�nhorizod elteretlon or iddhbn '\>• ' 1- - ,r-• -_,,..•'s;=:-.",1f,•' ' - • - f'-...• V=k , to this survey Iso violation 0f _ ,.w. --+;-,.-„,,,-.-....,:ef•.,--/. s'S;--. .„*' 'fou`i.T='as-n�-!;,,'_ro__ _ ';J+'q'-' ,„,-.,..,,,,,,,,..,--i5,5,-,4,77 -,'-F'- _5-• 4;�'' ':t ' t- Section 7209 of the Now Yah "''�`'•%. ' !, - •�'v.r s ',�,.. • „• - _ _ _ - , -•,,,:�,, 7177 -_ «��„ _-`'4:�hfi-7,,r,,.•"' FMcatlon LOW. 't�_t'Fi!' - - -,'r,;,-.? '•>r:.�•,v,":,'"Y ',':i;' ti..,r',�.•'.,y-.•:.:t'i, ._. ,"+:.�,t-X,..'.",./,....a: _ t vr,-:-',.,',..74., ;y Coates of this survey RIM not been9 ..:S, fi • `J� t?! ;•,;•; %d°-k' 4,' ''<'' ,, ! _ ;•'.;*`-''`_•% , 'd , the lend survercee baud coal a - • -• `i%'-"',' '.. }'�''y'' ,r, '.,'.' :',..:-''''..,'',-. 7' l embossed seal shall not be considned .moi i, , i"; i { 1"�G;'`'-r,Y r -, w; _` - to be•valid true copy. ']:!--4..,,_ - '•:l, `fs••o., _ -,'� i .''s•�'•',-,t,.'Y;.„ -'•,, ^ r.,."'ta:- :,i.:- <l:e'�•4`�{,' •i ,• `r'Guarantees nj_ i ...r->.:.,'-eQZZ E..yri y . - ei `-.`,o .i', .Indteeted hetsOn dutl ru �r..'ti ` _ i! ��a..,i�"'C�R:Y't'°>�'iY;''1--- �y ~` �f „`'!, only to the Person for whom the survey ` - »d:`ti ,{'°ur"` ':ti;;w.'-_ ry',,t: i'- ��'' '5- e,,'4,-.:-.;`,-'.'1,-,7-"^-4;,‘4:2,'2..,--rad ;.''.= r ,-.'' ,C`21'',ry" _ } Is prepared,end on his behalf to the , ,,� 's. `r^�-'V'`Jl ,,• 'yt, " '” ,*„:<•<•,•' t.:t r-.;� 't:`�'r%"'r -,;.` Ff 6 *le comport.governmental agency std \s...1;:', //.lam,J/ _ ct „,,e:J �`-r!; rA�q�,T`,,.i* .sr•,'�S N�� , tv,nTc _ »Vit.ts5q�-�lNz �. :.fG1Pit.' .'moi' /�7. ^ •r1 `` } dl Inomnion lined hereon erN + V,?' "` .` -c'-',.„- Y '-�f4c- •�B'ten n9 Y" q ':ia.-'" b • /1t.,- w :, ,itrYs'•!S';': '� �� •the eeelgnoes d the IarMing Innl- " ',:" >•:f , ' .."'" ":4'. ?c .,_, a,'`4. j i': 4w �i.. 7,3- , 1 .,toi:, �,••'rrc -U' L,_�.n�C ti_Y.'/� r-4-,r _-- C. 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