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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK
11?)
t P.O. Box 1179
REGISTRAR OF VITAL STATISTICS t $ Southold, New York 11971
MARRIAGE OFFICER ® '!. Fax (516) 765-1823
417 Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1963-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MCCARTHY, PATRICK AND ELLEN
Mailing Address 1 2780 DELMAR DRIVE
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 2780 DELMAR DRIVE
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-4814
Tax Map No. section 125.00 block 4 lot 11 .000
Cross Street G I NA STREET
Date Of Last Pump Out 0/00/00
Issue Date: 8/27/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c3vFFO(,- - c�
Town of Southold ACQ ' Application No. /Y 3
Judith T. Terry, Town Clerk Y ts� ‘6,, �'•
Town Hall, 53095 Main Road -4 $10.00 - Residential
P. O. Box 1179 � Y � ' z $25.00 - Non-Residential
Southold, New York 11971 6444
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Telephone �,( ��
•
(516) 765-1801
TOWN-OF SOUTHOLD
t
SOUTHOLD WASTEWATER DISPOSAL DISTRICT .
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 7-f ?- 9 a—
OWNER NAME: Pcdr( llen ifeCar -h c •
OWNER MAILING ADDRESS: A7 'O beiniar Dr. ) Laure-I
OWNER PROPERTY ADDRESS: c„50:, ►il`e
OWNER TELEPHONE NUMBER 0261,- t/
Tine Wo.
TAX MAP NO. : Section Block Lot • f
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing €/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
r
ignatur of Applicant
RECEIVED BY':'- • __..
Town Clerk's Office
- -
DATE: �------ � -- •
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1- NOTE' ■a MONUMENT
G' SUBDIVISION MAP FILED IN THE OFFICE
e.:iSti
• kOF THE CLERK OF SUFFOLK COUNTY ON
Cti� �� JUNE 22, 1970 AS FILE N0.5486.
9589
GND SURTO
REVISIONS YOUNG & YOUNG
' JAN 11, 973 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
SEPT.12,1973 ALDEN W.YOUNG HOWARD W.YOUNG
PROFESSIONAL ENGINEER AND LAND SURVEYOR
I UNAUTHORIZED ALTTRATION O1 AD"ITION LAND SURVEYOR.'LT S.LIC NO.1211.40 .k N Y.0 LIC.NO.43093
TO THIS SURVEY IS A VIOLATIG, JT
SECTION 72CR OF THE NEW YOLK STATE SURVEY FOR:
EDUCATION LAW
COLI•'.1 T'IS SUZVLS MAT NOT RAI NG EDWARD M REECE
'HI" ' ... ' ''.S,Ei pSALGR LOT 39 OF "LAUREL COUNTRY ESTATES"
1 WI '•L 1 A 5 A„Vol ET CONSIDERED
10 I t AA 0 F UI CAI.
OVA t 1•S r01-.ADD HEREON SHALL RUN
OILS TC IHS A SON FOR WNCAT THE SURVC AT GUARANTEED TO.
IS Pit A L..,A D J;,11.5 B.HALF TO THE LAUREL HOME TITLE DIVISION OF CHICAGO
' TITLE CON ANT,GOVLRNMLNTAL AGENCY Alp TITLE INSURANCE CO.
LENDS,G 1 ST IATION LSTLD H.R(ON,AND TOWN OF SOUTHOLD SOUTHOLD SAVINGS BANK
TO INS ASSIGNEES CF THE LENDING INSTI•
.....-
TUDOR
To AD GI/MAZONAL INlS ALL NOT R SU/MOWN(
/�
10 ADDITIONAL IHS111VTIONS OR SURS[OUTT� SUFFOLK CO., N.Y. eY � �[�"'�`,�__'
DV/E1x� SCALE. T CAT E: N .
I�� 040 T SEPT. 13,1972 72-696