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HomeMy WebLinkAboutDrell tecof y �s rri Town Hall, 53095 Main Road 10:09R V ' P.O. Box 1179 ® � o" Southold, New York 11971 JUDITH T.TERRY : ���'•• FAX(516)765-1823 TOWN CLERK TELEPHONE(516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 107-N Residential Non-Residential X Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner DRELL CORP. Mailing Address 1 P. O. BOX 1526 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 MAIN ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-2288 Tax Map No. section 61 .00 block 1 lot 7.001 Cross Street HORTONS LANE Date Of Last Pump Out 0/00/00 Issue Date: 4/18/90 Judith T. Terry Southold Town Clerk (TOWN SEAL) `O'FFACE OF THE TOWN CLERK is gf 'l Town of Southold � .,f_ ��OG= Application No. 1 U� Judith T. Terry, Town Clerk Town Hall, 53095 Mainin Road . � � � � . $10.00 - Residential P. O. Box 1179 - �Lilt*.,z ���•.,�1 � $25.00 - Non-Residential Southold, New York 11971 O `® =2' Telephone OIrstY►� '� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD:WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ (91 ,T DATE 47/6e7,4# OWNER NAME: P31,-,-, �lj�27 ( 41-•Tr OWNER MAILING ADDRESS: -TQ 7 /5-2- 6. ,_70GL OWNER PROPERTY ADDRESS: R/9//f/ JJ/ e/ 3'x14 /-1, %/ OWNER TELEPHONE NUMBER: 7 s-- TAX y TAX MAP NO. : Section 61/ Block / Lot -7. CROSS STREET: /Dif, tor it. /s- Z_I TYPE OF SYSTEM: Septic Tank New Existing Cesspool � New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: ? 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 BY: RECEMprn Clerk's Office DATE: APR 18 1'9 ) 1 ► t' gt 17 Jr /1\ . ',,,fl., A. W Stoke / 1 q !i ;.g ' I .60°3/'.•e 2 ,E ///.B/ n i o v 1 .:, 2--+ _. / Grr r. / ✓fAp ac- PROS.6- 'T Y . -9. ., -.7- r"` f lir . •.) s_ . A o T © fou P, /\0' - .,, `� >� b / A44... / ,r C) it / '� 6'"cif. ��!„ , s 1 ��n 1 1 0 = o/7uift7e6'7 - . k k. Q 0 f t P J 1_idmVR108iZE0.aLlcuwlivn ue AVOIDS!, r� i 10 5'SIIS SURVEY IS A VIOLATION OF �� re:710N 7209 OF THE NEW YON STATE \ 4 \i '! I.DUCATION LAW. LO .�'�, `sly,fit. • `i� / 7OPIES OF THIS SURVEY t.1AP NOT LEAUNC i�CJt��c ! NE LAND SURVEYOR'S 1\�i_IJ ST,LL OR 0 �. 1i � �+t Q?1LBE A SEAL SHALL NOT c CONSIDERED 0) t1 IQ FSE A VALID TRUE C:: r. �-' Q l (I 0UDARANTEES IN:IC5.ED s'EF=CN SHALL RUN l ONLY TO THE PESON FOR WHOM THE SURVi 4 IS PYTPARiD,A'4D ON I.'S BEHALF TO THE .zs.qI U 1 p'LE COMPANY,GOVERNMENTAL AGENCY A'- r 3d�' �o Mi I ',ENDING INSTITUTION LISTED HEREON, ANC Nor�o� if 1 W fo TNF.ASSIGN:ES OF THE LENDING INSTI l. f i3T8O z.GUARANTEES ARE NOT TRAPESFE?n'' SIir""12Oe�'1s''-66""70 _.._.__ r4 ,,,rr,4..,,.„ ' ' C'uns_ , civ-k awe' 7/0 Thi 7?// e.':,(7f 1p 'te-e- eP.,Aiat a/g 'r.5 . • 6GrrVe,,J/ C' �e.6, --; /-`? :3, lr• . V 41,x/,-•- 1 "..4......^. 4/47:45P/7.34.-6/ ,Lzz 4!'i of 7.9or..�;