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HomeMy WebLinkAboutFisher 1 ' 44'If OLir JUDITH T. TERRYO� Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS y Southold, New York 11971 MARRIAGE OFFICER el", Fax (516) 765-1823 -e® Telephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1825-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner FISHER, BERNARD Mailing Address 1 53 BROOKFIELD ROAD Mailing Address 2 City St Zip UPPER MONTCLAIR NJ 07043-0000 Property Address 1 1730 OLD ORCHARD ROAD Property Address 2 City St Zip EAST MARION NY 11939-0000 Owner Telephone No. 201-7116-0728 Tax Map No. section 37.00 block 2 lot 7.001 Cross Street DOGWOOD LANE Date Of Last Pump Out 0/00/00 Issue Date: 12/24/9. 1 • Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK •COFair '• p S Town of Southold �� :- CQ ' • Application No./ Judith T. Terry, Town Clerk Gy Town Hall, 53095 Main Road =a -� ) $10.00 - Residential P. O. Box 1179 �` $25.00 - Non-Residential Southold, New York 11971 O Telephone Q( 'I1Nb • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE /a l /, /q OWNER NAME: l - OWNER MAILING ADDRESS: A DD ��o�-- k pct ‘ r----- OWNER PROPERTY ADDRESS: - 1 7 1,CrS4 +• 1G r C�n // 7" ? OWNER TELEPHONE NUMBER:LQ J — '7 -YJ 7 - F 1©c0 0 - 57-3_ ~1, I TAX MAP NO. : Section \f �O Block Lot 64 CROSS STREET: volcocociLQVL TYPE OF SYSTEM: -Septic Tank - = -- New Existing Cesspool ✓ New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: 600,' 6-7/ I [ 47) LOCATION MAP: Must be attached hereto before permit maybe issued. (Locate building and system; give north arrow and feet of distance, approximately, to building and closest_.road.-) .• - - 64 j ai,ak . Signature of Applicant • ,RECEIVED BY: 1' T, , • - k's Office DATE: DEC23199/ Tovm Clerk Southold • • 7 11 ,.__� M - - = - •r it • jpQ .`- . ",hd.ravE?E . , _ "cr'' BE1ZN-2:4 'R. 041%1ARY FISH ."---12: • !Y.:671(4i'P,:58°58i 3C E. - 130.0- ' ,c tiT� • �` i,,: ;7f�r v 5�6�ruKrr - ; i 'w ? ek5 a' mArm _ - ' 1 LIS Walt- FENCE at ( T1MBBiz {f� �� TO\M1�1,•Gr ,<,71.L) �-?U:.,r '\1,�`tr,, ; , - - -- - - - - ___ r .SNI 1 - . w LJ, i � �t 1�. AO s;octU>jE i=erne Co. / \\I ' c L C.';1 I. ` 1i L / .' T. r el ,/ . - ' - 'r • I Lrnc ;a£s-r:•r?alteration or addition /� • - • - • to t,'1 survey is n violation of Son 72C1 of the New York State ((�• ', .. - .I t COO Sof INS survey map'not bearing --- ,Z.LI —" / - ' the I pd surveyor's Inked seal c' S embossed seal shall not be considered 1 d to be a leoltd true copy. ,_.�,,': -1: Guarantees indicated hereon shall run only to the person for whom the surrey 0;° P-1 Q Kum EiN�T is preaared.and on his behalf to the title co,npany,governmental soer.cy end d f�1EA k�y-7t�- S. ler,l:rn institution listed hereon exist I"titeL 7 Lt • to the-aslgnaes of the lending insti- z.ulen.Cuter,„sae are not transferable to se,ationai Institutions or subsequent If ow:iers. • L !.KITES • I. LOT 1925, 2EF5E1.TJ MAP �� =ECT,Tu1G S�P.;� ;F,WE GUA2AP�TEE'D 7.1:2 +LOBE M~ 12TGAG CO, ITS K•C.t� +021 t'.1Qi42 ASSIGNS: TOT G E ., Ef Y E'S�'"kTC'y Pi LEL', 1i.! THE SURF, ),CLLR 2+r'S _oF NEty ; H'E JtJ 2 IAF i �S 1f, �' n,} . ;5 -- - - ---- ------ r‘c. Va 'Lb :it-AnAt,,ITEEG T'J ECLIR1T` •TITLE StGUARANT`,f-GQ, i,__ _ _ t r� �_ 1 ') /L AS SU �1EYEG ,SUN ,t9g1-4• 5I.Jr, 1, ...l..i T�^� f'1! •.TJ P•L A, 1,;X:,A.,� S 1 - 2- (.1 iP-L1,,'''�� n..1 G _ (-_...}�n. !��'+f�}+( �JfJ tri- �+,� ..�- +1 , -.._.��J..---_ �� -.. _...__ _- �tY.14 d' r O - f t E[ 1 C +-1' V!_ Y\I TU/I •' }'r., /-DP :t.��� GJ.12P,1�iTFEc h.��IED- JULY $ lg ! IW (AP�D _...._..._ r•� '__� j � _• ,,,r. r,.- . 4:-. Ii. , --..._ ._ _ _7 .--moi.--,- q•+fr!�;k.Frf� - 1 —�. _ .. - -- _ - t.IC.t,.Al,i0 e-JRVEYQrr; , '—-' ' riREENR `F2,T V- ,