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OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3 Residential
Non-Residential X
Fee $ 25 . 00
Septic Cesspool
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NAME OF OWNER: William and Dorothy Boscola Jr.
OWNER MAILING ADDRESS: Mill Road
Mattituck, NY 11952
OWNER PROPERTY ADDRESS: Old Mill Inn, Mill Road
Mattituck, NY 11952
OWNER TELEPHONE NUMBER: 298-8979
TAX MAP NO. : Section 106 Block 6 Lot 3
E
CROSS STREET: Naugles Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: August 8, 1986
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Judith T. Terr
Southold Town Clerk
DATE: August 18, 1986
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK COFU(ir
Town of Southold Application CQG: Application No. 3
Judith T. Terry, Town Clerk y
Town Hall, 53095 Main Road ' 8 ` e - < Residential /
P. O. Box 1179 ` cn ; Non-Residential b•-"*"..--
/
Southold, New York 11971 OO 1a *.$
Telephone _ ,(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
•
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: OL/► //Z. X% ) 3te>yr 11,645?h, �-
OWNER MAILING ADDRESS: JIZ r
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OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: c9f e cP979 •
TAX MAP NO. : Section (® (c) Block (p Lot
CROSS STREET: GG=cj
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool v New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: / /4'
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.)
Si nature of Applicant
RECEIVED BY: 4c.ryt_ez....._ a •
Town k's Of ce
DATE: a...7 /f,-, 19,X
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SURVEY FOR
WILLIAM BOSCOLA JR. & DOROTHY A.BOSCOLA
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A MATTITUCK • DATE JANUARY 3
TOWN OF SOUTHOLD SCALE 1" = 40'
SUFFOLK COUNTY, NEW YORK NO 84-1078
*UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANTEED TO:
SURVEY IS A VIOLATION OF SECTION 7209 OF THE
NEW YORK STATE EDUCATION LAW WILLIAM BOSCOLA JR. 8 DOROTHY,
*COPIES OF THIS SURVEY NOT B ARING THE LAND CHICAGO TITLE INSURANCE CO.
SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL
NOT BE CONSIDERED TO BE A VALID TRUE COPY
*GUARANTEES INDICATED HEREON SHALL RUN ONLY TO _ �'�� ' NF�y,
THE PERSON FOR WHOM THE SURVEY IS PREPARED. 7. §`
AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- f is,nCj W `
MENTAL AGENCY AND LENDING INSTITUTION LISTED 4`P"
HEREON,AND TO THE ASSIGNEES OF THE LENDING �I . O
INSTITUTION GUARANTEES ARE NOT TRANSFERABLE "•'"- ''
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT ,:; il.
OWNERS ,
*DISTANCES SHOWN HEREON FROM PROPERTY LINES j
TO EXISTING STRUCTURES ARE FOR A SPECIFIC '
PURPOSE AND ARE NOT TO BE USED TO ESTABLISH ��
PROPERTY LINES OR FOR THE ERECTION OF FENCES
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.. *��, AND LAND SURVEYOR NY•S.LICENSE NO 12845
HOWARD W.YOUNG,LAND SURVEYOR
N.Y.S.LICENSE NO.45893
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SURVEY FOR .
WILLIAM BOSCOLA JR. a DOROTHY A.BOSCOLA
A-: MATTITUCK DATE JANUAF
TOWN OF SOUTHOLD SCALE• I" = 4C
SUFFOLK COUNTY, NEW YORK NO . 84-107,
*UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANTEED TO: •
SURVEY IS A VIOLATION OF SECTION 7209 OF THE WILLIAM BOSCOLA JR.a DOROl
NEW YORK STATE EDUCATION LAW
*COPIES OF THIS SURVEY NOT BARING THE LAND CHICAGO TITLE INSURANCE CC
. SURVEYORS INKED SEAL OR EM, OSSED SEAL SHALL
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