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HomeMy WebLinkAboutSilver Sands Motel • • OFFICE OF THE TOWN CLERK ` .S FQ(� `' _ Town of Southold ®® ., �' � Town, Clerk ` ' ,• Judith T. Terry, a� d, Town Hall, 53095 Main Road P. O. Box 1179 ``x' 4i' off+ Southold, New York 119714� Telephone al (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1 Residential Fee $ 25. 0 0 r Non-Residential X Septic Cesspool X NAME OF OWNER: Silver Sand Motel OWNER MAILING ADDRESS: Silvermere Road Greenport, New York 11944 OWNER PROPERTY ADDRESS: Silvermere Road Greenport, New York 11944 ' OWNER• TELEPHONE NUMBER: 516-477-0011 TAX MAP NO. : Section 47 Block 2 Lot 11 CROSS STREET: Shore Drive TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing X Residential Non-Residential X DATE OF PREVIOUS PUMP-OUT: July 19 , 1986 • Judith T. Ter Southold Town Clerk DATE: July 29 , 1986 j r . COMMENTS :i (TOWN SEAL) Bottoms, ito be 2 ' above ' water table. " Ili OFFICE OF THE TOWN CLERK ,c3VFFO(,( '- Town of Southold �� CQG= Application No. / Judith T. Terry, Town Clerk �` = y Town Hall, 53095 Main Road - - Residential P. O. Box 1179 . Non-Residential !/ Southold, New York 11971bi- 'O�• Telephone _O! Art 10"/ (516) 765-1801 TOWN OF SOUTHOLD • SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ 07514 DATE 7'1 7 0' /"/ '1 mor• z OWNER NAME: f Q /� OWNER MAILING ADDRESS: cf(�///F//C,. I A /2h- a/p1,7Mo 'LT, / OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: 177 40/ 1 TAX MAP NO. : Section i2 Block Lot CROSS STREET: OWE— 'YT o'c .,z)ie/dL TYPE OF SYSTEM: Septic Tank New Existing - Cesspool New Existing I/ Residential Non-Residential l/ DATE OF PREVIOUS PUMP-OUT: 7' /9' D 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 Appint ak, RECEIVED BY: ( T�c, own erk's Office DATE: 7 07cf/R .r. : -.:,. '''.:;:-;..-k' ''''''45,C--,4' '''',-;;....':1.,,4:•:.7.''''.•,,t14.....0.4 *A".,x0o.•.-.,,--.' ''''' '1 •-*,•.:64A-:, ----7•0 - . ' ' - - - -----, Di ag‘rarn (locating building and cesspciol. Give north-aTriiCiv"La-nd'feet of dis"tance, - approximately.) . , , , • , , , , ..- ,..''' , • , • , -4,, . ‘,.'-;:=1..,..''. •,,, ' , ., • --, .'''';, : . „ •,z, , „ =b .)2,,,,,,,,,:•4,,IA:•,', , .,,,. - , . M4.17.T. / ,.,-,.,:;.. •';',"•44 r 2. .4,,:,.., :, .'4Z1'•1.,EV-- ,', -C,, 4 :;-. : t. -2.„1,' . -.., ; . . . ,y,f...0.,,k.l.fc..,k.T.:vi ,,. i:-._: ,,;k," •'1! 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E , .'• - , , - .E 44,M. ‘,:,•'!..-,• .''' -" • ' ' •'' E'''!•.r.'...•.•'••'' - ''''l ,1-• • ,, I hereby certify that the above originated within the Town of Southold at,the above location(s), and to the best of my knowledge, contains no chemicals, hazardous or toxic :•.':' waste. All statements made hereby are made punishable as a misdemeanor pursuant to - Section 210-45 of the Penal Law of teStat6 of NAki York. '.•;- ' ,,,,....;ii-,,,.;:•:•-, , ,::2;fo.-..g.;-'• - '" Tv--',k, ,:'.-'7',,:',:s':=;••%,K>:.;';,(0I''';',4 - Name of Driver.'. . :‘ .. . . .,: . .',„:, ..:0.•-i-:,:cV. . .':-.777. .-.1:';;,,,,'.';',',. ..2'. — ' ' --,,.; „"'• .-‘,1i,,,,,,,,!,:' i;',7! !,,,,, - , '''-',Ifer'01,44't ',';'?`i‘E"'..`"' '•',',•Eti.'•;4;;'.':i.',',.,,1,;;,,,,',,•,,,,,if,,,,1 , ,„ ,,,,, : , t"'''''" • ' " : i,NF,:',' • :74,PNY-:-,!A k:r..-7 i'.4: .:1;',iA 1,'"'• ''''"'.',,% . ,,' •', • • • --,>,:- ,-‘t•-',1,.,(Ii.,::e..' -•c.'- Signature of Driver ,4-,,:. 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