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JUDITH T. TERRY ;! Town Hall, 53095 Main Road
TOWN CLERK , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER '.74 c� � "" Fax (516) 765-1823
r_® ���!!'� Fax
(516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1640-R Residential X Non-Residential
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner MAC I NA, MARIE
Mailing Address 1 P. O. BOX 304
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 3145 OAKLAWN AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3872
Tax Map No. section 70.00 block 6 lot 7.000
Cross Street PINE NECK ROAD
Date Of Last Pump Out 2/00/71
Issue Date: 3/14/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
yy ,
OFFICE OF THE TOWN CLERK c\\ FOIL
Town of Southold C' _ Application No. / G
y �,..., G pp
Judith T. Terry, Town Clerk . �'
N:,s:;* $10..00 - Residential
Town Hall, 53095 Main Road _
P. 0. Box 1179 v' C $25.00 - Non-Residential
Southold, New York, 11971 O •® •=','
• Telephone' •�j `�
•
(516) 765-1801 '
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC- TANK or CESSPOOL
Operation Permit No •
Fee $ /e _ , . •
DATE II) RHP/
OWNER NAME: HA-/Q_./ ' fl �,�A
OWNER MAILING ADDRESS: 0, 5 c ojL '
OWNER PROPERTY ADDRESS: 3 / 6 LA a,,t) A V
-.300T-140G /N � / / II /
OWNER TELEPHONE NUMBER: ' 76)5— 3 �7
TAX MAP NO. :_ Section 7 Block Lot 7
CROSS STREET: I ! i/J I ClC
TYPE OF SYSTEM:: Septic:Tank ' -New Existing
Cesspool ;/ New Existing. 'V
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: / 67 -74
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 of Applicant
RECEIVED BY: t I _ .-
-' Town Clerk's Office
' DATE: 3A ���� .
if i NOTE' NOTE,PROPOSE;' hr._ r, P.A:'
WETLANDS LINE AS PER EN-CONSULTANTS TS . lREF.N DEf i? + ,41NI,wl1�:
loC'sr_CM WAIL- TABLE AS fP_-,y
HI S1,f i A!,4 (AWN Pr SAI TAR Y '
' A a nes 1;LAT10,US ARTILE 4 . .
HUM IS 1• ��� ,,G ,9�9
DARK LOAM 4• !�� G O \$ �r• t'� SS�A�.
SANDY LOAM 1.5' ,1 o 2 �$ 00%0
100
.
,OG 29 �04'S�P 8
2
LOAMY SAND 2.3
p6Adk CO
PALE COARSE - ._ )t I* Kiln
SAND 14.4' 6 4 O
. WATER IN COARSE W
BROWN SAND 17' 2.7 r.O i
Prepared in accordance with the minimum
standards for lite surveys as established - t�
by Inc L.l.A.L.S•und approved and adopted Q 17-,)
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for such use by The New York Stole Land 2 <x to AY
Title Association. 1\
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"ti< •,•,'e:r supply �r,d sewage disposal Z ! �\ >.r
- :' .ns for this resider 'e will conform — " I Nie 1 I•
'0 -he slanda•ds nI TI• Sullolk County GI ` �toP r / ;•/ 2� Q
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- ?7,.17 76.18
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V• CHARLES D.
p,j HARDY a.O
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- CERTIFIED TO : _
,I RENA TO STARCIC
PINE NECK ROAD
SURVEY OF SLIFFOLKCOLINTY DEPARTMENT OF HEALTH SERVICES .
PROPERTY- FOR APPROVAL OF CONSTRUCTION ONLY
. AT SOUTHOLD DATE HS REF.NO
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y. APPROVED
l 000 - 70 - 06 - 09
Scale 1" = 30' i9 LAND%
Nov. Il, 1987 •
co MST?�F iF
Mar. 21, 1989 /V 1. 9 O 'ti,
JULY 25, 1989 ( building envelope) ,�f'.1,41y
Aug /9 /989 PLOP hs� ) `1i..4lj,r it i' N.Y.S. LIC.NO. 496/8
Aug. 28•' :989(eevislon)
Aug. 27, 1990(revise) \til�•. RS, P. C.
cs ` r f/
MAS
SOUTHOLD, N.Y. 11971
87 - 866A