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HomeMy WebLinkAboutBlum 4 r JUDITH T. TERRY . Town Hall, 53095 Main Road TOWN CLERK tv P.O. Box 1179 REGISTRAR OF VITAL STATISTICS 4 Southold, New York 11971 MARRIAGE OFFICER ^ ,;i! Fax (516) 765-1823 ,& Fax Telephone (516) 765-1801 ,s2s OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 129-N Residential Non-Residential X Fee $ 25.00 Septic Cesspool X New X Existing Name Of Owner BLUM, REYNOLD Mailing Address 1 BOX 709 Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 PECON I C BAY VINEYARDS Property Address 2 MAIN ROAD City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-7361 Tax Map No. section 103.00 block 1 lot 19.011 Cross Street STILLWATER AVENUE Date Of Last Pump Out 0/00/00 Issue Date: 5/12/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) ' , ;OF'FIrlg OF THE TOWN CLERK COp /t)4-`� r'' , Town of Southold ��� . CQApplication No. A Judith T. Terry, Town Clerk Town Hall, 53095 Main Road . ' ` 7 $10.00 - Residential d r P. 0. Box 1179 crs t `,; ��`, $25.00 - Non-Residential Southold, New York 11971 O •O. � 1aO���` Telephone (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. / 8-- g Fee $ �j DATE ,'//17 7/ /7 72 OWNER NAME: L[7rJ &-3 OWNER MAILING ADDRESS: Bal' lay �" • . C ce To l . .y. OWNER PROPERTY ADDRESS: X44.1,-) � OWNER TELEPHONE NUMBER: S16 ?3V 73d TAX MAP NO. : Section /�-3 Block / Lot / CROSS STREET: 17-/i. t.eaCTF.4 TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: N�t,c_) 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 • • ! / l RECEIVED BY: Town Clerk's OTfice • DATE:- .5�/%/•� ,� `�Z -._ ---- --- -" - -- - - - -- - BEET I.J,EaT T.AI�I 12O,AD TATE ' 1JY, 2.6 �.loTE: ' \ (::PJL.I G I--.1 4TE12 L itilE. is Loc.A.TEP 5 > - .AiL E8 E.A.sT oiJ ^ooU7+-1 rV.RPoR Z Rq�r� IBJ so LJTi-!o_v / r(02.0' hl 49° 3I'ooS I- I92,z3' \ tL,20,0-, O \ 1-= . \ , ` , to CC >. Lu w , . I SAN ITARY SYSTEM As - © 1 N5PEGTED 13Y liSALTFt DEPT- 0 �`�p- EX15TI N0 Izao GALSEPTIoTANK. �� PARKING AREA_ _ Z S'-O"DIAMETER Err 5'-o" �� DRIy�WAY DEEP, Two "LEA VI j I I / Ex - T1t�C, 9�rJ T,v�Y I POO lS� �'-o�� p7R M ETE R io 1 _,,,___________./. �/ s BY B'-O" p EE P --- STEM 'Fp PE-A84Nt +Je.o / I 60, • ' vIN >� EYPm o FIELD'3 - �' I \ 0 �8 �' ' FIITURe Exa•,TJ910�J---�►l r d 1 Z 0 A i°So FT �� •D.LJ9 or, n4'C �1iNEr2Y/sE ��1w , ED SArIt^GARY 5r(�3TE,A \ vi' i I2oo I \ ,LLS o2 CJl"r�EFZ Q � �Z ® I . >f2y SYSTcni1S 1 ,63a)-1 / \` U o�1rJD 1.- •r' ; e w o ti 1_� `/ �b 0:11 \ �/ �� ��T I ! eo I sBo'''' -' Iso?r F. , J �. x 5 -�� -- —? -- xISTNG' 'fir% IJO O,-`I-lc R L-1LLI_ C F>r c- r- i- �v�0,1•/, �2 `...Ni-La2Y SYS i-til I WELL I W 41 (1 I 1 tr \