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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® P.O.4PZ
Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
O Fax (516) 765-1823
MARRIAGE OFFICER _ ��®
�/_— Telephone (516) 765-1801
32
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2003-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool - X
New Existing X
Name Of Owner MACROS, STEVEN
Mailing Address 1 830 SUNSET DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 830 SUNSET DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4762
Tax Map No. section 106.00 block 8 lot 37.000
Cross Street DAISY ROAD
Date Of Last Pump Out 0/00/75
Issue Date: 11/13/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
iii
OFFICE OF THE TOWN CLERK 'SWFFUL4 '
Town of Southold Application N'o. c0C6
Judith T. Terry, Town Clerk 67
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 crs r, r ' . $25.00 - Non-Residential
Southold, New, York 11971 O�i ® " �
`910
Telephone .� y
al
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: �� --42.ky
OWNER MAILING ADDRESS: �O
OWNER PROPERTY ADDRESS: _o _
OWNER TELEPHONE NUMBER: AC?'`P(?.+C, �
TAX MAP NO. : Section Block Lot
CROSS.STREET:
TYPE OF SYSTEM: ,Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: tot 7'
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.)
11.E ,
�r Signature of Applicant
RECEIVED BY: _ - _ - -
- - , . Town Clerks_Office
REMO
DATE: -• - .-
- NOV Igq?
•
Town Clerk Soutliolc -
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a:MONUMENT --- - -a}-
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suooivIS/ONMAPF/ O 'THE OFF/CE
A R..9 /970 ASF/LENv 6�4BNTYCYV
:I -YiOUN &--YOUNG P "F- Nell, i
400 OSTRANDER AVENUE, RIVERNE N *Fs �' Fit
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PROFESSIONAL SLIRVE I. ENGINEER AND C
• LAND BIIRVEYOR, NYS LIC NO, I?H4y
SURVEY FOR: ��'s'}..
�' INC. '
UNA,IT/ItIRIIIO ACTT-RATION OR AUDITION TO R• p. HODSrON SONS, °• 45393
,111, SURVEY IS A VIOLATION OF SF CAT IO LOT NO. 50, SUNSET KNOLLS, SEC ., •''ys o%
• I20B OF THC Nt'W YORli STAY! EDUCATION Ill SND SURlt�
L,Aw • •
1 COPIES OF THIS AURVE Y MAP NUT BEARING
THE LAND SURVEYORS INMEO SEAL OR GUARANTEED TO:
•
EMBUSSED SEAI. SHALL NOT BE CONSIDERED AT NNATT/TUCk SECURITY TITLE B GUARANTI"Cd
' '`� TO SE A VALID iRUE COPY
• SOUTNOL O SAVINGS BANK '
GIARAN'£ES INDICATED HENDON SHALL RUN TOWN OF sob, n ,
CMLY +b ME PERSON FOR ,NHOM THE J Ll �l [_
.-.4':, 10 IS PREPARED,AND ON HIS BEHALF ------• By ,
,-.s',. 10 ,HE T,TLE O 111ENYS ASSIGNEES
MENFAI. SUFFOLK C O , N, Y, /y/dt/Q/1�,
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• + AGENCY AND LENDING INSTITUTION 119TE0 ,�__�! F ,
. LENDING AND �I TIO ASUONEEB OF THE //- / lT /5
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LkNDIN6 INSTITUTION OVARANTEES AHE SCALE: / , ✓ ✓
•� NOT TRANSFERABLE T04DUIT WNAL
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