HomeMy WebLinkAboutK&D Assoc OFFICE OF THE •TOWN CLERK
Town of Southold A� , .
Judith T. Terry, Town Clerk Z = w: �'
Town Hall, 53095 Main Road
P. O. Box 1179 '. -
Southold, New York 11971 Q �ON._
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Telephone - 0.( [
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR 61 Residential
Fee $ 25.00 Non-Residential X
- - Septic Cesspool X
NAME OF OWNER: K & D Associates
OWNER MAILING ADDRESS: 31855 Main Road
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 31855 Main Road
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-5657
TAX MAP NO. : Section 97 Block 5 Lot 10
CROSS STREET: Harbor Lane
TYPE OF SYSTEM: Septic Tank New Existing _,
Cesspool X New g X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Te
Y
Southold Town Clerk
DATE: February 16, 1988 - -
_ _ (TOWN SEAL)
OFFICE• OF THE TOWN CLERK • I ,j�FFr4L'''=
- Town of Southold �V % CQG' Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
; Residential
` .
P. O. Box 1179 -�� IOW , Non-Residential
� x 7
Southold, New York 11971 O ®
Telephone
(516) 765-1801 . 1
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ✓u (`p
Fee $
DATE "'0(4)
�/ l ( 4)
OWNER NAME: c�'' D � S' OG 1 ' 3
OWNER MAILING ADDRESS: 3i fS'S' ,'2-
/ 7' //71J1
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER&4) 7 d 5/-" ...4?-r7
TAX MAP NO. : Section /0 0 ('' Block 9 7 Lot malt''
01
CROSS STREET: - LscL�J�
TYPE OF SYSTEM: Septic Tank Il New Existing V
Cesspool ✓ New Existing V'
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ONxrypws✓.., 02eg,vy6L,E /est 7i/ix
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.)
7
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/ Signature of Applis '"
RECEIVED BY: n ,(je,
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To CI rk's Office -
DATE: /& fr
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r l.37058120yE. . £ 0.•! _ _
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MAP_ _ .�.f l O . PROPERTY _ _ •
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e �'s ? AIFIHORIZED ALTEROE1 UR ADDITIOR
1./. `- C1= CIO THIS SURVEY IS A VIOLATION OF
8 ® - -W JFC�JON 7209 OF THE NEW YORK STATE 'r
( 4CL' %s _ FA ATION LAW.
�JT�1 •i�9 4 6S ry ,' ® • RQP1Ei OF THIS SURVEY MAP I�O ARIF.G • A
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PIE LAND SURVEYOR'S IM(s)'SFEM.OR 1
- N a 40 ' ROOMED SEAL SHALL�tOT t(CONSIDEREa
-0 ..:0_I :C:!i- (f') ` e' ,,,, , -, LO EEA VALID TRUY/CCOOPY' -
t N� yam. ��( ~� Q P�ARAN[EE5 ICI1TED HEREON SHALL RUN
.� di pltLY T9 E PERSON FOR WHOM THE SERV.
qCO S T' 0.'��'',,j _ ) ,, IS PREP RED AND ON HIS BEHALF TO C F
6.Jjob_ .� `.?" IiCO ANY,GOVERNMENTAL AGENCY E
int —+ LEND INSTITUTION LISTED HEWN, AM
z �-�a5 I HE ASSIONEES'OF THE LENDING INfiT'
0 IOEh GUARANTEES ARE NOT TRAMBFE. v
4 .wry' / �p� r/ /'- f ADDITIONAL EFA��n ttTwc rn cults.
.3a6-S,Ib.d_�Cad Y Sf iO•�r�1""f G.�J r (t/ S�' A/ �h 6..., 7WNERSa
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." _ GUA2ANTED TO T€-IE SOUTHO DSA iNG5 BANIt , i
�,I_�`J ! 0,�$ GUAT-Ai,11EE) TO THE C4!CAGO T;TLE §N5U kicE CO. #
- - • P5 5U12VEYED i2R: � 3 f
3.� 0-NUfrfE`'41 - - - /2 10/
SUFF. CO, 1 .`.C. MAP_'.a03 -97.5-10. 1.10.LANE.; SUt �JEYt;fes:. I�E i IP°W l N �'
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