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JUDITH T.TERRY �11��� y�c Town Hall, 53095 Main Road
TOWN CLERK y 2 ; P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ��Oy %! , Fax(516) 765-1823
MARRIAGE OFFICER 4� _At- 4i Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER 1 4t *°;101
FREEDOM OF INFORMATION OFFICER ,.i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD-
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3398-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner FLICK, HANS F.
Mailing Address 1 P. O. BOX 433
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1200 CEDAR POINT DRIVE EAST
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5906
Tax Map No. section 90.00 block 2 lot 21 .000
Cross Street MAIN BAYVIEW RD/CEDAR POINT DR
Issue Date: 10/20/95 Judith T. Terry •
Southold Town Clerk
(TOWN SEAL)
a , -
OFFICE OF THE TOWN CLERK so Ur"'
;own of Southold , 0��� `�wt.\- Application No. 3 o fj l
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road -� $10.00 - Residential
P. O. Box 1179 cry ;' $25.00 - Non-Residential
Southold, New York 11971 640
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Telephone 0 ��
';'',(516),:765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ • , ,
DATE c®/,.-lq
•
OWNER NAME: (1a C,
OWNER MAILING ADDRESS: p.e . b&L 415-b
4AynkttLD , U
OWNER PROPERTY ADDRESS:_ per® f-R. Or DIL _e 4
iy kid i
OWNER TELEPHONE NUMBER:( i9q- - 5o( // ( -Q-) ��Lo - hoc o
TAX MAP NO. : Section 050 Block ®O- Lot al
CROSS STREET: HMO 6Pnt\I7 C,eTAQ.. 3)(Li
TYPE OF SYSTEM: Septic Tank ' New - Exis_tine
Cesspool —7—New, Existing -
Residential ‘,../ Non-Residen-ial - -
•
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 Applicant '
RECEIVED BY:
• Town Clerk's Office
DATE': ' .
:_ AR p01NT �R '
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N. 73°32'27"W. f,e i10e 99.86'
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LITT L E
AREA = 26,362 SQ.FT to tie line SURVEY OF PROPERTY
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CERTIFIED TO : B A YVIEW .
CELESTE KIME FLICK TOWN O F S OUTH O L D
CITIBANK N.A. ITS SUCCESSORS AND
OR ASSIGNS, AS FIRST MORTGAGEE SU F F O L K• CO UN TY ,_ N.Y.
CHICAGO TITLE INSURANCE COMPANY
9108-02390 100 0 0 90 - 02 - 21
Prepared in accordance with the minimum SCALE III = 40 '
standards for title survey's as established JULY 25, 1991
by the L.I.A.L.S. and approved and adopted
for such use by The New York State Land _
Title Association. ,
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tie ,,r 1 .Y.S. LIC. NO. 49618
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'") C. TC"$SU % MORS, P.C.
-''1,�;•°• y '0 LOT NUMBERS REFER TO "MAP OF CEDAR
s. LQ�1) � r09 BEACH PARK " FILED DEC.2O , 1927 IN THE .
MA , ;• OFFICE OF THE SUFFOLK COUNTY CLERK
SOUTHOLD, N. Y. 1197/ AS MAP NO. 90 ,
D. K. 88 — _137 -