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Home My WebLink AboutLewis Qeki ), Town Hall, 53095 Main Road ��tic O N, P.O. Box 1179 �,, �� Southold, New York 11971 JUDITH T.TERRY ,,`•��,�� TELEPHONE TOWN CLERK (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. 3595-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner LEWIS, BURT G. JR. (ESTATE OF) Mailing Address 1 P. O. BOX 983 Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 3600 VANSTON ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-5533 Tax Map No. section 111 .00 block 5 lot 12.000 Cross Street CARRINGTON ROAD Issue Date: 3/06/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK �FFpc Town of Southold Application No q5 Judith T. Terry, Town Clerk 53095 Main Road $10.00 - Residential Town Hall, � � �, �ta1 � 7wX L4�r � P. O. Box 1179 mow- � n � $25.00 - Non-Residential Southold, New York 11971 _ ` •• Telephone Telephone ®141 1%' , is (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /o DATE ,;1, OWNER NAME: 0..,(>/, OC 2 U2! /i/3„u/'J' i l� OWNER MAILING ADDRESS: BOA/ 9cP3 • lNz ~-,) y //93,r OWNER PROPERTY ADDRESS : 36®® /,� � .✓eb ( �!/4JY'v OWNER TELEPHONE NUMBER: 73 y J'S33 (2„•=4„,/,..5 TAX MAP NO. : Section f// Block Lot / v CROSS STREET: _2/j96%-).4/ )J 4- TYPE OF SYSTEM: Septic Tank New Existing Cesspool / New Existing V Residential l/ 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.) x04) lei;uvl f Signature of Applicant RECEIVED BY: Town C rk's Office DATE: g / \ \, y' D —.--0------ - z4 5.49 O-�2 S,47- 7 "5g- ( c� 2 O• ,_ • VZ 106.79 J 0 i \ - / C W I 0 C421 O 5 O F4-. iL gni�D 3 -v ' S `p_ _ �_,o )-7-S-------‘ iii - &- •OS Ff '� N0 ••. ,': r � e� �, 0• t-vets_• ' . N -C) , /4:1.- .•—r".'. ' ' - - -. . , ! ;:lu%jj � Nr•:: - :?rte - 'K'• _ - _ r�. :•'-.' _v. ,'x� ,vr..'�� cc. 'r-r 1 ilT. - _ - - -.fir 'F, :r.f.. �-i, '2'r - •v4' �1, :i d iL 'S .avid - ?IS- .O 'Y.Pi� C Thi• -!S -y:i'' - `*Y 7+.' r�t4 - It ••:hh• '.ri-Yii'�!l: •S'N//��- '.. 0: ,��Y' •-,4•.A f( '7 x- ,J. ••.� 5.,.r�''";:.+�h }. ii'.'"' 'r', `.Z.: ;'^ 1 _�: _ :tom, .< �,' ti'-` _Ti. - :;� - "asa`F. ".X-7=1L.:4--;22.-"- L.:4 .?:� _ - lll:,i - •�• - _ jl_- --11-a7. ' - :,7••' .`.5�' �..-1w_, .i i�''..s,\,13 1 i J O .�` 6 • 1" 40 N_ - 1a ` N®. LS �0 Lia ti 14•b-1 5 , .. NSED�.. ,- --- e , �o �`� 6,t)� NCL � �- O------ -co •cm - ��-6o� �.� -.� Pte® ,,� ° 'c% 604-a tjC4 ,, .....----\ e'4< s'..s� �P� �� GQ �. ,.� moo; 4 �' tit ACP. 47 ,N,'1 '0 O\e(-v3,0.'.‘Zo ''' - �'