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JUDITH T.TERRY ��o �� ♦ Town Hall, 53095 Main Road
TOWN CLERH P.O.Box 1179
♦ ® 0! ��
MARRIAGE OFFICER � Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ♦` ®� Fax(516)765-1823
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RECORDS MANAGEMENT OFFICER ® '�i 1'" 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. 3381-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner LATHAM, STEPHEN AND JOAN
Mailing Address 1 37 KENWOOD ROAD
Mailing Address 2
City St Zip GARDEN CITY NY 11530-0000
Property Address 1 60 ROGERS ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-746-1198
Tax Map No. section 66.00 block 2 lot 19.001
Cross Street ORCHARD ROAD
Issue Date: 9/12/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OAF_Tt E TOWN CLERK �frF11`A
Town of Southold , 0��� CQ Application No. 33e/
Judith T. Terry, Town Clerk y .
Town Hall, 53095 Main Road a -< $10.00 - Residential �^
P. O. Box 1179 to - ; $25.00 - Non-Residential
Southold, New York 11971 O *-$
oma
Telephone �y Oj ��` ',•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
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APPLICATION
for
OPERATION PERMIT •
SEPTIC TANK or CESSPOOL
Operation Permit No. /358 /<
Fee $ /0. 00
DATE 6 Seprefi4t3ER /995
OWNER NAME: TEppi lv y JogAu L0941-rr)
OWNER MAILING ADDRESS: 37 KEILIGCJODQ POgg
6fikary Crn./ ,-,/1/ /153d
OWNER PROPERTY ADDRESS: 60 ROGE/eS ` ofih
N Y 11971
OWNER TELEPHONE NUMBER: 5/6/7��. //98
TAX MAP NO. : Section 64 .00 Block 2 Lot /9 00/
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New /CO ' t.Existing
"Cesspool New (Z1 Existing X (71
Residential X 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.)
/ tune of Applicant
RECEIVED BY:
ToiSMIVElls Office
DATE: SEP 61995
.lawn Cleric Suffield
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1 Unauthorized alteration or addklory - - - — ` i _ _ ,_. w x _ + i
to this survey is a violation of
Section 7208 of the New York Slate ^" 'Y't„� r
i t. 11 ,' is l', r ..- 4
Education Law. r �'•�••••c
i Copies of this survey map not beanng �' r-r-, j rL. r Z r« ✓��� N`�/
the land surveyor's inked seal or 3 [ ,-P”f L_,•, ' r-t , r--<-! ;"1 r` y.�'. ���P� �`GK Vq�
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embossed seal shall not be considered "' - _�_•__ �1 ` O� ,
to be a valid true copy. �� O , . (�� , •
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Guarantees indicated hereon shall run
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i only to the person for whom the survey L.J r!)E,1 7 1,y(;4)L v, :t/, i ;�` yi riP+.
is prepared,and on his behalf to the _._ _.. __,___-— i O �� c �� i
title company,governmental agency and ~R�~ _,_. `c�i [ 562`Jco v/�
lending
ion listed
and
t the assignees of the lending insti L.� ' . ``a�U LA rJ D SJR- i
lotion.Guarantees are not transferable
' to additional institutions or subsequent
owners.
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ifti+l7 •• f4 '' MAP AM4✓ 4t)EE A4)2,17,19.95; .1
` •• MAY 12,199S 1
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