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JUDITH T.TERRY °� -`r, ' -,74: Town Hall, 53095 Main Road
TOWN CLERK ; ,_ h '`. ; P.O . Box 1179
o-� "`.rr°b' _ `s''` Southold New York 11971
REGISTRAR.OF VITAL STATISTICS ' , '
MARRIAGE OFFICER � � 1�' Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER 1:1 *of" Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,o'0'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3557-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MACOMBER, WALLACE AND GINNY
Mailing Address 1 P. O. BOX 632
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1115 WHITE EAGLE DRIVE
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-4562
Tax Map No. section 127.00 block 9 lot 21 .000
Cross Street PECONIC BAY BLVD.
Issue Date: 12/03/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK icvFFO(,(-��'•
Town of Southold
c
, - Application No.
7
Judith T. Terry, Town Clerk �H ��
$10.00 - Residential
Town Hall, 53095 Main Road
P. O. Box 1179 cn ` .,` r-t1 $25.00 - Non-Residential
Southold, New York 11971 O ® 0
Telephone _ j • )
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0
DATE //
OWNER NAME: U0LR!..----`y‘9//f/'�V /aeU/ng�2
OWNER MAILING ADDRESS: fr-228 630? ‘./8G/«Gy1J
, rfrta /() / M)5,71-•
OWNER PROPERTY ADDRESS: ///6J///7-4-
// 4/R7_--4) /Ufa //f'f
OWNER TELEPHONE NUMBER: S/6= S%,</,�`602-
TAX MAP NO. : Section /cZ Zoo Block Lot o7/ 000
CROSS STREET: `I G=GWL1/C ‘ 72f U-D
TYPE OF :SYSTEM: Septic Tank - X New X Existing
Cesspool X New Existing
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.)
Signature of Applicant
RECEIVED
RECEIVED' BY:. - ;D;EC 21986
Town Clerk's Office
DATE:'..,r Southord T®W11 C9elrk
%-
`--,TEST HOLE / IN
LOT /8 OF FILE MAP
7770,FILED 8/30/84 -'-10/60 *10/00
4100 45 +100 00
"-102
2 -1-c
ti
0
+10/35 WHITE a-10063 EAGL E DRIVE
+/01 85' f/00 2 99 56
CONCRETE CURB
`- ASPHALT
' S 32° 33' 42"E" PAVEMENT _�
R . 520.00A=35 4/ 148. 78'
At I
STAKE FD 11 \ / 100
R=25.00' O \0
A=39.27'
D_ 99
70
0 CA
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N PROPosEO °?
y CESSPOO
03
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rn -\ � • 98
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SEPT
OP
POSEDIC NK I
0)OQO� �1J
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v I 97
35'-
PROPOSED
r 2,400 S F RES/DENC_ .
O
y
IV 40'
O
7 _. _ _ 25' GARAGE
25' 60'
6
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PROPOSED • 35'
WELL --fir
10'
i
N 32° 33' 42" W /84./6' '
N/F RASWEILER y
THERE ARE NO WELLS, SEPTIC TANKS CESSPOOLS OR
RES/DENCES OF ANY KIND WITH/N 25'O' OF THIS
PROPERTY
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