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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK •
® r-r• P.O. Box 1179
t1' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS "10 l Fax (516) 765-1823
MARRIAGE OFFICER '=' 1 _. �® •" Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER '77® 4 ��
FREEDOM OF INFORMATION OFFICER �
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 145-N Residential Non-Residential X
Fee $ 25.00 New X Existing
Name Of Owner TAGGART, LINDA
Mailing Address 1 P. O. BOX 249
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 68320 MAIN ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-765-1053
Tax Map No. section 53.00 block 2 lot 2.000
Cross Street PIPES NECK ROAD
Issue Date: 12/20/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold c5\\V o
� °; , CSG Application NJ-845-A
Judith T. Terry, Town -Clerk'
•. : . : :F esi•entia
Town Hall, 53095 Main Road "
p. 0. Box 1179 cr3r,;y� {; . •
'25.00 - Non-Residential
Southold, New York 11971
Telephone Slat-
P
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE / a- 3 - 9
OWNER NAME: � iAlb t � G� �' (
OWNER MAILING ADDRESS: RO• 30k o249
cOLk ri, cA ir1 - ( l \9t ' I
OWNER PROPERTY ADDRESS:- t13 y v 04 W t to 2 M
G, Frm 7ovk. ay 119 q —
OWNER TELEPHONE NUMBER: Si (a %S- )os - \js "`l -SJ7 Z
TAX MAP NO. : Section S-3 Block Lot
CROSS STREET: �, ,' e�/� d44,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New X. 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 •uilding and closest road.)
Signature of App i -nt
/
RECEIVED BY: 1 , -
own Clerk's Office
DATE: f � 3 / 73
JUr1ULI\ 1.UU1111 W.I.hI%11111-111 VI II 4.111
c'___ •
approval of Constructed Works
-. H.D. Ref. No. ego- 93=-6M
.,_ - -� Pole 496 The sewage disposal and water supply facdi;ies at th1
• x __!�GUARD RAIL -----
-----_____ �` have been satisfactorily mspedttl by this Departmel
- -----< ___ in compliance with these as-built plans
—__-- DEC.,O 2 1993 'it' Li" a•• Ca o'• 1
P
-- - _ _ _ ___ DATE CHIEF OF GENERAL
-` ' ' SHo-- -uLDGp _ _ _ ____ _ _ --
- __ - ENGINEERING SERVICE!
/ ,
•
•
PAVEMCNY
- _ _ _ _ y • SUFFOLK CO HEALTH DEPT
- -
- - -- -- _ H S NO C1`
', � 1 r-- F '`r^'1,1 `T-•,}/ ` __! 5 H OEQ C J�L - '___ _--- - -----__ _- __ - •
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1-1/6,11,4STATE') '
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11✓ f-,. I t--',.._:: 1(--1' e 1 G1�AtZ�_-Y 2A"- Z„ IO° WATEC MAIN '- 1 1
---- --- "TT=h —1 -ro clE s +�ec1� ROAD---
- -- c ' - STATEMENT OF INT
r E, N.3c` 35 :"C,G, 7,6.45_ r . -.
F i GULVERT,,JALL �'� a'`� p,° YDRANT THE WATER SUPPLY AND SEW
-�= r✓ •✓ 1.)E GONG. - 4._1.- -- I. - 1 b• Foie 888 -`----
f , F.� / j3_Q -POLE887 ..lAwe , Z �1
SYSTEMS FOR THIS REST
r ' �'I - )' !'� r. :'•-.\t" rr / d1 _ _ H SIGN CONFORM TO THE STAND!
' j( I- ' CI i W '1 SUFFOLK CO DEPT OF HEA:
'r 3I J 'i 1 �1 - (5) - -
�I m APPLICANT
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.l`O /W/ 1 B L Li E� S T 0 N F j' I x '
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0-, .p/ yl ' eP N' :- : SUFFOLK COUNTY DEPT
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SERVICE'S - FOR APP
O , (�`) (L - CONSTRUCTION ONLY
P A P. 1¢ O G � 2 U ----J----1'-ss-----(
?-j '- "• DATE
J ' b2 Q l32 u,� W - H.S.REF NO. CIO- 93- OC
(�/ I I Z u •
�% i /_- 61 / m i cF , APPROVED.
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/J - _ - • . ---. T- `-✓ 1 W SUFFOLK CO TAX MAP DE
//� I -28 . 1 Z SECT. BLOC
�� j/ y` DIST.
x ,� , I' STU2Y i2AMP. o r :, ul 1000 Q5? . - 2
/ \ , tau / \ �� '+ fl ' 1 OWNERS ADDRESS: {
�= tiC ` F2Ar 1E BLDG r
�, 185 / .-. P....Box 249 •2:s
�rA LE ��- fir,• •/ 'i/�A. . I �2ETAI SALES) USG) i I s0!.'THQ' D NY;If
G- I Il:i-i--;LIT 1- -, _ GONG Glee p • ; „�,._ `7; _- - - .��`
IRII E — - j ,� A c T w t 75s lcs EG j;749`13G1
1528 S,- �`/ I • n` loy, i - ,
----
ARIA. 5 O N /' DEED: L.N/A P. •
`� \ TEST HOLE
/ -18 / oma'os. ° R �`thus �G
/ - I 47, - - Ee x 72re of tl,el
vio
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D� boales a u s nivn
V / / `, 6 � . , . - �,.,. ,�1 C• ” . i !� ``�o LaW sunarofat
` lr'bossad seal sltsl
• / - Ic bo a vaad true caP
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P - - = ,, ' „ . - I ,cess f0OL _.-7. , ]Ny to the person 12
�.J . , - . - - _ `'.�,1), iro - ,. sprepared.and cot,
/ r_ 50. 4 t .,,-• ,m -s ... --• _ Na company.goer
,. - w"• 9 .:..31_�,�._ •. andmy insetueena%.
f i s ,1 c," t - le i:,., ;: •
,ti,``,'" - •'1. '', ,o the assignees cif
/7 o �� 28 20'v'/ R�'1%S�1 1,t°� 114.7,7•. '532 35 ?Q,•W 1. , „ . , _ roaen.cl,arnta.it�
�9 �,! - Owners. •`.1