HomeMy WebLinkAboutSimonelli `stf Wire;
Town Hall, 53095 Main Road,
�� � P.O. Box 1179
i•
�'l' Southold, New York 11971
JUDITH T.TERRYr•--4-__111 ��1�,h FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 100-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner SIMONELLI, GREGORY
Mailing Address 1 P. O. BOX 1190
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 140 PIKE STREET
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9796
Tax Map No. section 141.00 block 4 lot 4.000
Cross Street LOVE LANE
Date Of Last Pump Out 0/00/00
Issue Date: 1/10/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
;1-OFFICE OF THE TOWN CLERK C��FF�(i'
Town of Southold �� ;;, 4 BG- ' Application No./i/R /06,
Judith T. Terry, Town Clerk �� ,4i; -. y
Town Hall, 53095 Main Road V.4r. :< Residential
P. O. Box 1179 '`ti ` �!
cn ��� :' ,�•� z Non-Residential ..--v'
Southold, New York 11971 %).• ® t%:.i y;O•,'`�
Telephone '4Q( _' ',
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
,
for
OPERATION PERMIT '
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
. DATE lr
OWNER NAME: 4 i.c 64-y /,,?. ,n�,a--Git
OWNER MAILING ADDRESS: A? `/2'
s, Or ' ff 9e /i- r Z.
OWNER PROPERTY ADDRESS: HD AA-4 .
OWNER TELEPHONE NUMBER: -2-9 9'77
{
y TAX MAP NO. : Section / W Block y Lot
CROSS STREET: 'cam -
TYPE OF SYSTEM: Septic Tank 'Z New Existing v
Cesspool ( New Existing (/
Residential Non-Residential v
DATE OF PREVIOUS PUMP-OUT: 9-111 . / 2-/V
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.)
G
7 Sl a natureee of Applicant
RECEIVED BY: , (10/Ar-"^-2.
Town Clerk's Office
DATE: y (p /9v ,
..., ....,
.
. .
.r. ..,•••••,.......5
. :
6 .
-
,
( t t
e l . •,
• • .
• .
. . .
• , •
'4 . ' •
' -
.•
. .
• .
•i,
. .
. .
' .
•
t ;
•
. , .
•
• •
, .
• .
•• . .
• ,
. .
• , . . . „...„.
.1
CC
d fik
5 ' .
• •
,•••
el
. ,
e
•
• •
•
• .
•
ilfe .S 1:4.,41,,
r 66 zo• ,a -a-
' \
? % et• i
, ..
'0..„7"... ' t• Yite
•
561) •' s.*
(o* I•
•
%.s. T.
ss6 r
o . ..
..,
-..., N 0 -A
• el\ ‘ s .
t‘N
..,,,, , e • 0 ' ,. , . ,
..., N•sb....,
CZ. ".. 1 6 Cl""
N
0 .
. •IN C. 1 0
-,• c•
fr.
. c...
0 11.-
-'. . .....e.
,
•
•.1%
• Lk
1/1 .
• cr%
.
'V k.'
l
1.. . i:
-a
' • . .....a.. . .
. 0-
... . Ul
• .,
ca.
'• ts,
.4
IIN
0-
# .
..•
ILIN
C... 0 ..,
..A
C. .
i
Z. i$1 I • '0 ,
.41.
ON..1
4.(..- • ilto
'Olt1, ••• 4''
r 111‘ . . 0 :1761.311 9P .
. . .
r . 4•.
off.
. .
•
,
2. • .y
; . .
0 6 OF- S•7. f GO.
IA $•
.7..• \ ill tA t)51
.e... • - .- . -
\ 09 010
cr%
,
I
! . •
. . ,
\
• , . .
i . .
.•
•
' . . .
if . - . .
.. .
.
•
' .
Unauthorized alteration or addition to this survey Is a vlolatIon of
.. .
section 7209 of the New York Slate Education Law.
Copies of this survey mop not bearing the iand surveyor's inked
seal or embossed seal shall not be considered to be a vand copy.
Guarantees or certifications inclicatet! hereon shall run only to the
person for whom the survey is prepared,and on his behuff to the
lab company, governmental agency and lending Institution listed
hereon,and to the assignees of the lending institution. Guarantees
or certifications are slot transferable to additional institutions or i
subsequent ol,,tress.
. • ,
. . .
. .
. ,
•
• ..
• SURVEY FOR
A OF NE4,
• P' k04)
GREGORY SINIONELLI c3 cRT A. df-
*021 'tit
•
AT MA r T/TUCK 45„
.UARANT FAD TO'
. TOWN OF SOUTHOLD
,
ig
.1 • it
SUFFOLK COUNTY, N.Y. NI•IF, iv•sTrofiA KMERICAN TITLE INSURANCE WMPANr Or
i
r .11•;?-,,
G EGORY SIMONELLI
..A , Q-
SCALE : re 008
%'to,. 28725 -6)
NOV. 4, /980 1/0
'fb 01.4(1.' Xf444,1-1-a w4:4--
(AND
LAND SUAVt VON .
y, s
N.itt LIC.. . 10110
111VIAN. A,. .1('
'
..,3
4'.5.9t1
I ,w,
- .. ___ . . _