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HomeMy WebLinkAboutMalone (2) ® JUDITH T. TERRY ttr. I Town Hall, 53095 Main Road TOWN CLERK ,. P.O. BOX 1179 REGISTRAR OF VITAL STATISTICS : r � Southold, New York 11971 tr Fax (516) 765-1823 502 MARRIAGE OFFICER . 1 .�`� t � Telephone (516) 765-1801 A,4lat OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1722-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner MALONE, ROBERT G. Mailing Address 1 P. O. BOX 275 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 HORTON'S LANE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-4092 Tax Map No. section 63.00 block 1 lot 8.001 Cross Street SUNNYSIDE DRIVE Date Of Last Pump Out 0/00/00 Issue Date: 7/09/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) ewe OFFICE OF THE TOWN CLERK •c�\\VFair Town of Southold � >. C'QApplication No./ 7 p?j� Judith T. Terry, Town Clerk Town Hall, 53095 Main Road $10.00 - Residential C= P. O. Box 1179 cn - $25.00 - Non-Residential Southold, New York 11971 •O Telephone '4/4—,k# (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit d. Fee $ PO' DATE :p cl)AJ (cC( OWNER NAME: go @G-2'c" 6. t (i4L.0/U& OWNER MAILING ADDRESS: H O RTO N S l- }?o B )(. 2:1-5 uT)-1,00 tvr t191-1-02, OWNER PROPERTY ADDRESS : M toAi /ANC- SO c Wt,_D., 'kik() OWNER TELEPHONE NUMBER: (6--7) s ii-©?2. - TAX MAP NO. : Section 63 Block O ( Lot 08% 1 CROSS STREET: ,1 (-) (VlJ`f S1b6-- D21,ve TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing ✓ Residential 1/ Non-Residential DATE OF PREVIOUS PUMP-OUT: ',ONO 9'O 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.) /e4 Signature of Applicant RECEIVED BY: n Clerk's Office DATE: '9 n°1 JUL. Q �' 'c �' j, r- ' 1 ) ., • 6,\ ,,,, , N.GaB'b3‘10"C..-~-� 4-II. '7'7' ' - rx ., tv:on.it t . p t- t- V ! ., .. .... , , \. _ _ _ CO SI1 I rf 4 ,..3\ of 61.8E. 61.0 IS.o' 1 I • ✓ • (1 I I'rnAin r1y N ,`ri c0 o , 1° co 3 ° ,r ° c. ��� 2 • DfD` .,-,) ° 59,<o9 �OT.O 125.0 -0 k 2' [� �''2 TO •- - D T l 50 NI NY cl t©� ? R d A D 0 AJ -L � i, t,,' ' in 4 r - ` -.----___ --- -_-_ S 6 c S 4 W. TsS .,g , �.Q r.l c n ✓ L d , cI n 1 L, t , F..!.. _ C._ p . ‘p• 0 - �--------- 4.6‘ -- > • C rO H 3 suav�Ey Isnoll of ADDITION - '� '•�•"•..•—• a //�� //,�..�� A�/r ``` ON 7209 OF lllf NEW YORK STATE - • • e .r ��L,�l. Y u�"Il'v 7 ` ' i Ile ., , • AiION J • coT1Fs of THrs suav T ' THE ' s sL YE CY MAP NOT SEARING r K YO ►GF E-SEp SUL Sf1ALLN T FE CONSIDERED So u`T--�-t a�. �N. Y _ S y o�� , 94 7 •� / A VALID T: DERfD r UE COPY, - ' I GUARANTEES,[INDICATF Y SHALL RU _ �J. �`. , ONLY D HCRFO, �{ / `hOy' ! 1 / r.,soN 1, N - I7 IS PREPARED,AAD L P W'OM THE SUgyEY • IITLL CO '''''‘DIN HIS F.11AU TO r II v MPAN7.GOYS 'ME C �. ,ZIAYVf'•�C Y.,, - I ' tr oNDIM1G II:sTIrUTIUN l 5 FD/(Aq,AGE�O�Arip V G C' O ' ^ ,••- / L 1 G G Ei t>e , HE AIS IGVF A11, _ f _ 1 , TO AUJ Gr IONAL INS 'END'ARE NOF TRANS ETRAELE ' - __, _ I IlES: oFu X tt6 14©: - h xr�ivlPcrfi I`J'Y; tR1$. OR&LenoUEF' C- a_ .- - r_- -...__'_______._____ .. . -sir: 6 g ) �� •.-. 0r oR• .._,_ __.`' i