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Home My WebLink AboutKmetz ey oil OFFOUr OG JUDITH T.TERRY 4.# � Town Hall, 53095 Main Road TOWN CLERK 2 P.O. Box 1179 Southold,New York 11971 AEGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER iy te, Fax(516) 765-1823 ® RECORDS MANAGEMENT OFFICER = ®� l�t moot 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. 3727-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner KMETZ, KENNETH Mailing Address 1 540 CONKLIN ROAD Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 540 CONKLIN ROAD Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-1746 Tax Map No. section 139.00 block 4 lot 5.000 Cross Street OAK PLACE Issue Date: 11/24/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) • OFFICE OF THE TOWN CLERK OFO(kO�. Town of Southold , c.��;r ., �Q Application Judith T. Terry, Town Clerk - > ;..• Town Hall, 53095 Main Road y, - $10.00 - Residential P. O. Box 1179 v' ' '_ k ` ► Z` $25.00 - Non-Residential Southold, New York 11971 • O r, ‘0 Telephone ..-701 + yi (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE Ii/L15/Y) OWNER NAME: ei(J /Y) ( '/L OWNER MAILING ADDRESS: 6--(10 C OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: .0' k 17 'fit �-< A/1 TAX MAP NO. : Section l0-'D- 13 Block Lot CROSS STREET: Cev‘lat, 1 i 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.) 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" Tkif• 1.-7N k, fikti suBDIVISION'MAP FILED IN THEOF'F'i1C.e"4 (. 7.;...\„C';',‘::••:-,1:i OF THE CLERK OF SUFFOLK COUNTY ON...-T'It '•,•; .'1111 • •ti,' •k,-.• ' J UNE-21, /929 AS MAP AO. 577 - '- ''•:,-;-.4'.-t\•..i ii L'-c, ' !‘ , 0.0 • THE LOCATION Or I'VELLS Al'ID CLISPOOr 5 ;"..., .,,,41. .:-11,;4 :__ --.7 -1 Sli•DiV 11 1! ?: ;:l ABE rcon riEt.r) CD:F.IVATIONS _ ave' 1.! , ),Aditaa-es, . --— ..1 5-.0 ..., , .reAd r4 e' 1 0 1•411\: finD/OR FROM DATIL 013111111CD FROP.I OTIIEIIS REVISIONS NOV /1,1976 , : ALDEN W. YOUNGYOUNG & YOUN ., ,p,..1 .. 400051RANDER AVENUE, RIVERH , PIAOrtlIttlIONAL ICNGINI'1111 AND LAND NUNIVAYOIN. N V N. LIC NO. 12D4N SURVEY FOR: ' ...,..,1 , _ , . • • :5;EviLotoF.i.ve4, • ,,,,,;,, _ 4-k i- •! Q., • ' , • , _ 7. . "::A'• .Y.• L • . '- 6 , .. ,.....1 .... 1ow .,. ,.. -.-...,is ...,...‘,. 1 A,,,,• Via.Erf t... trig, ,•..0. .4, •,,•1, Irviii bRiZtri3 )ILT ERA T ION OA A DOI I ION TO "Illik;WS . Y .;1 ,i1 II NMI f•09 A VIOLATION Of /ACTION • ADELP/1/ LAND CORP. . 0 .• LI gm 1k AWL EDUGAT PON 'CI . • 4-5 Bg ic. ,i.0):": i':,1,r/ ,•. • PART OF LOT NOS 47,48 a 49 4.14(0 '41 I;), .031- / 1I-1, ••1 : r n 1.410 siniS- -'..(rs••.,-',. '1.1. :I • ; ,- - ;; DiUDVt I' MAP NOT 2 CA AI NO GARDEN HE/Gil " --4, „few:We wnirr, •••Akt_ opt , ,..- ,_,:. ..,e• L.,. •--tf. •, (L.' A•6 CNALL NOT AIIIIDLIIED -- — , "'".••• 116U1 COSI AT GUARANI-EEL) TO: ., - ... ...II ,..le, ' • /VA7T/TUCK liOIVE ri 7 LE DIVISION OF Cli(CACOI; ..,:- 4,-- Al tD litimItm nUn • 'i. . '.' \ !,. tW•7 — rtas INSURANCE ca . ,..,./ 1 ;.• it‘r^e It . 447:014 von twits) TOWN OF f BD,04443 ow I, . a I COUrturr,Orsvk k./ZIPZIM Ian III u t' ;113114et itogruil .weiittnicm. bp,m, . SOUTI1OL D ., .... I.9Y , . ,I er L IV' SUFFOLK CON. Y. )cil 7/ . . 1. e s'•!••;:'1...1.1 '1 .01Ft4 IVezeiA,e)LL,_, -11-e...tt- • • ' • .•,; 4.kawiturkf tyi Apoil • ric • t ri, .. ,--T I D A1 r _ I NO. et' 1 •INj.., _ _ .,,--- ., . • . • ...: