HomeMy WebLinkAboutKyle •
JUDITH T.TERRY �� ''Ay4 „ , 4"'
� \ Town Hall 53095 Main Road
TOWN CLERK ; e ';4',i :)'-ti; � r= ,
;rr.,,:>? g , P.O.Box 1179
��� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(516)765-1823
MARRIAGE OFFICER %* �`�� 1�,
RECORDS MANAGEMENT OFFICER ee:/ �� Telephone(516)765-1800
143
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. 3317-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner KYLE, ASCENSION AND KEVIN
Mailing Address 1 P. O. BOX 1295
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 815 PARK AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1715
Tax Map No. section 56.00 block I lot 2.004
Cross Street LONG CREEK DRIVE
Issue Date: 3/31/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE 'OF THE TOWN CLERK H"�
Town of Southold �� CQ Application No. S 3( 7
Judith T. Terry, Town Clerk �` :' ;y.
Town Hall, 53095 Main Road 8 $10.00 - Residential
P. O. Box 1179 tri ✓ $25.00 - Non-Residential
Southold, New York 11971 O �','
Telephone ei * `� ��1
(516) 765-1801 /
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 7
Fee $ O•------
DATE
OWNER NAME:
OWNER MAILING ADDRESS: Pio /'� /.9 5-
i -/
n /
OWNER PROPERTY ADDRESS: • ''g—/3-"-
//
'g—/3
OWNER TELEPHONE NUMBER: '6-76 - 7(� S- / 7/ 5
TAX MAP NO. : Section 54 Block / 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.)
lam'
Si ture of Applant
RECEIVED BY:
Town Clerk's Office
DATE:
V _
CFkEEK D� .
Z...O LIG
000
rv' f
N
LOT /3 fr
I
/G/ 00 S
v. "70°38'50"' • Q
k W
LOT /4
W v
4-0,01-7 SF Q
U' 14
•
_Cr:Q' N
SiN 1 >
Y.rel-
's In
Q
a 33 49
a 3s ^
m Cr _38 A a LP
Q a 38 IL.1 f 49 N L ► )
rVf o WN 4. 5-rrpJ N /c,,
T • 4-
N)4.0 (+
2er,/,,,,=,;=>1l N —CH-3N ORS /E
0 510'
V
CI A-E
0 N /l`J'
�, r
Clr
0 o 0 N
41,1(
Si
•4-
P
FN
/G,/ 00
70 38 5
' 0 P
" S
THE EXISTENCE OF RIGHTS OF WAY LOT 15
AND/OR EASEMENTS OF RECORD IF CERTIFIED TO
ANY. NOT S OWN ARE NOT
GUARANTEED I • /<Ev/CJ c, E .°`ScEk-/S io,e-i FCYLE
FIOEL/7'y ,vaTiO.v.4L Ti TLE
//-_/3U,=k..4,VCE Co.
UNAUTHORIZ D ALTERATION OR ADDITION
TO THIS SURVEY IS A VIOLATION OF /VoRTH FORK 3An/K
SECTION 7209 OF THE NEW YORK STATE -
EDUCATION LAW
COPIES OF THIS SURVEY MAP NOT BEARING ` \
THE LAND SURVEYOR'S INKED SEAL OR \(.•S)•�`L sS-��, .) ( `VJ y
z.
EMBOSSED S L SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY THE WATER SUPPLY AND SEWAGEDISPOSAL
GUARANTEES INDICATED HEREON SHALL RUN SYSTEMS FOR THIS RESIDENCE WILL CONFORM
ONLY TO TH PERSON FOR WHOM THE SURVEY TO THE STANDARDS OF THE SUFFOLK COUNTY
IS PREPARED, AND ON HIS BEHALF TO THE DEPARTMENT OF HEALTH SERVICES '
TITLE COMPANY, GOVERNMENTAL AGENCY AND
LENDING INSTITUTION LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTI-
TUTION. GUARANTEES ARE NOT TRANSFERABLE SIGNED
SURVEY OF LOT NO /4 KENNETH H. BECKMAN, L.S.
MAP OF oGo _i 57-....c....--r- s. 3 o '€
/Fo• o , B7) Surveying and Land Planning
SITUATEq IN Sou-rHOLo ,,.•5�NFW y 5018 Exhlescw.Iy Drive South
TOWN OF Soul HOC_O ��.�4F`���\H r.Feto��, Suite 202
kr R'�l�-'
SUFFOLK COUNTY, NEW YORK i`^Y °%':11&•,,I,t "� Ronkonkoma, N.Y 11770
_* t A o (5 16) 588-0'180
nATF I I.'7.,=7 Q4. IOP NO Flo /44 7,SCAI F / " r 4 i�, eeaMt .4,