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HomeMy WebLinkAboutLynch afre JUDITH T. TERRY /�® A Town Hall, 53095 Main Road TOWN CLERK a; i"` g F P.O. Box 1179 REGISTRAR OF VITAL STATISTICS ® " 7- FTIPi Southold, New York 11971 MARRIAGE OFFICER , j` Fax (516) 765-1823 Telephone (516) 765-1801 A ED V . $ OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1721-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner LYNCH, JUDITH E. Mailing Address 1 79 KNOLLWOOD ROAD Mailing Address 2 City St Zip ROCKVILLE CENTRE NY 11570-0000 Property Address 1 4235 CAMP MINEOLA ROAD Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-766-3347 Tax Map No. section 123.00 block 5 lot 25.000 Cross Street KRAUS ROAD Date Of Last Pump Out 0/00/00 Issue Date: 7/09/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK iCOFUG-,'= _`� Town of Southold �� CQG' Application No. 2�rl Judith T. Terry, Town Clerk � ,"u' , _, Town Hall, 53095 Main Road �` ° $10.00 - Residential P. O. Box 1179 $25.00 - Non-Residential Southold, New York 11971 O ' �` r• 0�*"$ Telephone Telephone 0 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. /7 ,:ith Fee $ /e7 DATE 7 g q/ OWNER NAME: —. - U 1t74 ek. /y / ejf OWNER MAILING ADDRESS: 77 (f-,tie, 'te®® ci OWNER PROPERTY ADDRESS: 07.9,c. �,i,' # 'e '4/ A(4 7/4 c y OWNER TELEPHONE NUMBER: ‘5"9/6' 76g 33''7 b1?,6 TAX MAP NO. : Section /4 3 Block ` Lot a S CROSS STREET: ePAO TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing X Residential )C' Non-Residential DATE OF PREVIOUS PUMP-OUT: (99/ 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 Applicant 1 , RECEIVED BY: Town Clerk's Office DATE: I . ac.M+ya"mwaf✓wmMrC+,eys.aa.yy,.._..�.�. , a'aPb'u^ TAW.iM,rweraisyo.,.rw,myasv°uor°aum'4,n.r+m.s.... _. _ . s Z sc S l f \ kI \ , . ` beea.ti C4+' elel: o>f 9,;14t, . '\v-1-).', � Nabove' rrieati se 'tire.! -�r. '�+ i.: -''4 • ,, ' -i\ , dxa-l-t.yttt, Wit.,:- qll� Coul•t • c 3 • z_?, P. W. Ui :riaE �U1"-li�:t�_ ww��VW �t s ' ta1F:v. �® 0 • ✓ tlna+'thartz[rd thermion or addition .r'"{ to this sunirsy is o violation of �`� Section?243 of tho Now York Staid ,, ri''� ' rdacation Law. y '� Ci• �,. �O C c (i piss of this eurvey nab not boarin t the lend su 'e'ior's inked seal a v Q 4 N sinhossed seal shell not he canal&�-• ' �._ � • ____ ;14' t� "� _ -- Z Q_- ; - , t®be"A valid true copy. ®. . Z1 2 Guarantees indicated hereon shall run • ,Z�'� ®� • 1)1 G• 2rily to the person for wham the servo)` ! t •(1 is prepared,and on his behalf to the �--- fJ °' d • 'P Vile company,governm©nto a ency an,' r > lordin3 institution I et hereon end �. , > 3 to the assignees of the landing lnatt- 1" teflon.Guarantees are not transferable (' ZV l 46 A t AGE ' s Q t to additional @neututiona or subsequent ovonera. 11 , o I !' t SURVEYS; �f d LN . 1 E{� ramt t_ ; X .0 P'l,.1 �' J 0 ,, it-.,, .cel ) ,99 dm"` , P' \A"`IN H ' ii , 4 4.,),:; , .I. i‘4... ,1 @, ci, ICY . 1 1 �At_�' . - "30,!,..-.--- inti . • e l ! ye . ( . -- C 04%i C agr i~ Mi o N U r t E h4-- , , ter;` 4:. �' fir' ' ' ° ' 2Z-Vt SEta Auc,:28,i J89 - ., • • ,e a , Q" ` �r0 ,b,_ ;,.pF Nf �art,leivirs - °c•e.a ,ta' 1. 46,c1,�.k,wr'li' i 'fi"f�r . 4,.. ...-----'-''',' ,'Cr tr\v,,e, ' ' . '4).',.. -,', ,,,i ,,,c',,,,,,,,,,,,ni ii,„,:l. . .fau,, -71--- ' d yap k. , CC ,.,'.,',k''e < ._,,' f . \t..G-1 l9 1141';PF, " ,it ,aC • �Ai,9' rb�a'd,;.� ''''')-ONC .fir '',;s% ;.1ii�; t • a , (S 25' o" • ' .tc l' '.L � QS � .LAND..,'.e ' ti,.+:.lAv, '..1AP t' :.. �O-Y - '_ "" -'': �% , °".v, .+.sx'sc-m.sa.. tnYA�_`.:a.•.ocrKaa.m;.se aaagc. :a"r.a.c.yk.-..o-'irq: a,....--,�-wc,..v..=s..,Awe.,..-.......c - , e "` 'r. .'.-^^^tw�1'-..A?.ue....ra+•+v`...+.K+..•,w4iw•..i'hu.•+..wr.,.L..[