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OFFICE OF THE TOWN CLERK •c3gFU(A-
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Town of Southold �� •
Judith T. Terry, Town Clerk -wy
Town Hall, 53095 Main Road c� {
P. O. Box 1179 ���'
Southold, New York 11971 O • .$
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Telephone1iNg �►�O
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 24 Residential xx
Fee $ 10.00 Non-Residential
Septic Cesspool xx
NAME OF OWNER: Thomas and Marie Ficht
OWNER MAILING ADDRESS: 1975 Skunk Lane
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 1975 Skunk Lane
Cutchogue, New York 11935
OWNER TELEPHONE NUMBER: 516 - 734 - 5598
TAX MAP NO. : Section 97 Block 4 Lot 9
CROSS STREET: Eugene Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: June 1986
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Ju it T. Ter
Southold Town erk
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DATE: August 22, 1986
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' (TOWN SEAL,) • \`
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OFFICE OF THE TOWN CLERK .cvFFOCA-
Town of Southold �� Cali Application No.
Judith T. Terry, Town Clerk
,
Town Hall, 53095 Main Road o ' FR,
Residential
P. 0. Box 1179 � '� , i ; Non-Residential
Southold, New York 11971 O ®
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Telephone ®.(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•s'
Operation Permit No. 02 —
t ,Fee $
DATE
A' V/ I
OWNER NAME: 1- D'1/k_c d' 14.ik
OWNER MAILING ADDRESS: /976- vAv, L U re1-71o‘ve.
OWNER PROPERTY ADDRESS: / ti 4/11- 44 c L/Tc-N° v 035-
OWNER TELEPHONE NUMBER: � 3 '-� 5 S 1
TAX MAP NO. : Section 9 7 Block Lot q
eelekj.-CROSS STREET:
TYPE OF SYSTEM: Septic Tank V New Existing 1/
Cesspool New Existing
Residential ` Non-Residential
DATE OF PREVIOUS PUMP-OUT: / 9 OZ
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.)
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Signature of Applicant
RECEIVED BY: 647x
Town CI k's Offi�
DATE: ( ?
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UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209
THE•
OF
NEW YORK STATE EDUCATION LAW
COPIES OF THIS SURVEY MAP NOT BEARING THE UND SU0.VEYOR'S INKED SEAL OR EMBOSSED SEAL
1 1 SHALL NOT RE CONSIDERED TO BE AE VALID TRUE COPY ma
J I THEGUARANTEES
SURVEY ISR PREPARED,TIONS AND ON HIS BEHALFTED
ON TO THELL RUN ONLY TO THE TITLE COMPANY, GOVERNMENTAL AGGENCCY
AND TO THE ASSIGNEES OF THE LENDING INSTITUTION.
AND LENDING INSTITUTION LISTED HEREON. LE TO ADDITIONAL INSTITUTIONS OR SUBSE•
GUARANTEES OR CERTIFICATIONS ARE NOT TRANSF ERAR
QUENT OWNERS
ANCE COMPANY .STT-S-®®®T8
II GUARANTEED TO
CHICAGO
SOUTHOLD TSAVINLE I GS BANK
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�-. �:;I n MAP OF LAND LOCATED- 1r. CUTCHOCU
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`� ITOWN OF SOUTHOLD
t + +SURVEYED FOR
FIC
E
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49143 ��F{��
THOMAS VL MARIE D. F CHT
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4 / DATE: ' 27
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{ NYS NUMBER 49143 SCALE:
289 — EYORS
I LICENSED LAND S
- �, ROCKY POINT NEW YORK 11 T713 MAP NO. 14
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