HomeMy WebLinkAboutForman }
t 9 Town Hall, 53095 Main Road
# P.O. Box 1179
® �_ � Southold, New York 11971
JUDITH T.TERRY 1� ®� ', TELEPHONE
TOWN CLERK � (516) 765-1801
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. 3579-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner FORMAN, GENERAL STEPHEN JR.
Mailing Address 1 32 HOLLY LANE
Mailing Address 2
City St Zip SHIRLEY NY 11967-0000
Property Address 1 CARDINAL DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-878-0810
Tax Map No. section 115.00 block 6 lot 1 .000
Cross Street ALBO DRIVE
Issue Date: 1/23/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
� • moi.
OFFICE OF THE TOWN CLERK �o c3VFFO(,r
Town of Southold CQApplication No.
G
Judith T. Terry, Town Clerk .� ‘
Town Hall, 53095 Main Road g $10.00 - Residential
P. O. Box 1179 ; $25.00 - Non-Residential
Southold, New York 11971 ��`
Telephone 4,l IS?
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No.
Fee $ 10'.00
DATE
OWNER NAME: General Stephen forman, Jr.
OWNER MAILING ADDRESS: 32 Holly Lane
Shirley, NY 11967
OWNER PROPERTY ADDRESS: Cardinal_Drive
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-878-0810
TAX MAP NO. : Section 115 Block " 6 Lot 1
CROSS STREET: Albo Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New X Existing
Residential X Non-Residential
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.)
r a
Signature bf Applicant -
\ iG a2-to
A6 Jr peva old,vaiL
RECEIVED BY: 6
Town Clerk's Office
DATE: /- 023- 9 .1
"IL t;f`J:::,ii=.;.:Jg1„.,g.;`ts't Itn...'fat {may ..%'- `e..1
ALL r •�7 l ....... SUR r!,'.,.,..CT;twn;aG .•E ti�
ry ,%'�pi�YRS(�_Yri=/ i:u.}�•EASEMENTS „�.a Z�:rir SJ�tCC1 MAN, =�;'••I''
7iV•r'i� a'�' }�ff'r' ...]r,. -A.:> •...0 'aAt:Y _',}C [��1�`y. t�
Cf UNDEPOS0�`rlO UTH r iEJ icf L^) i. tc CATiOt+iS ARI: :+ •••i'..`P...'�C:V.1.. 1.` L. ..y` •• .^.., `Nnt. 0.'f!. .�+aS T.[fr) `-t 2 S2 y .�C
NOT SHOWNARE NOt`GU RANTErD 4E rtr l-!ER3 Jyt`!D ,<C:=, %d.'.:,: ..'44 -'Tr %il. L..s_ "^. S: J ' ^'c .�
• •' .. '+a':il'•: i fie a R" .1C.+,G rt.+O.r:Mq.:al.r. rL. =Xi. .nC. f
�;f i is t TO Lli.Lfi v GS:),.. -.Y 0� ,
Ain' NOT . :�,,, ° `_'i•-c a;. .g` x V E O LOT 5 N\,A P
+T •_f`VT.'fA: 7 -'..i,:. -,]C•. ,.-..1. '3:NF •,16 ,.
A �:'i�iG:+r�iLtiavy+7 a li'.Li.FOOLS, ..„:„.1
..� SUR
V @iii-^ �.II �" iA f• t
\ _ X t L"irr <.a' -'' r%1•i t•{�jJN J _ ,.L' n., o,^ a •-- NAA-11—
TO
I .
( A,„,::CA iip1. J::iLi VilCET � ;.aNfiki r.J .'.,f:V u+ y j{s ef VP `K 1 1� 1 1 f� ESTATES
J 3 ” .I 5 = " ' I LED SEPT 8, (5 2.. AS 4453
., T �j i--C GA-r E.D AT: M A TT-I TO GIC a
• TDtA)k) OP SOC)TF-10Lp •' SVF�L-K
to \ GOUnlT�! NEIN �OR 'Ke
W Zoo- 00 \ S c_-r- r i 1000 - IIS -6 - 1
o
0.° O __ - GERTt frtED TL7 :
ro-In yI J# Q GEJ.SERAC_ STEPHE1�1 t=OIZM�.I�I JIB,1.1 'N \ ` J 0 1 M1 U E PA R U{?A - E V EL-0 P M E til Tj
ip , SGTIC I /JC.
a ` lhril SUFFOLK COUNTY DEPARTMENT OF IEAt.TB SERVICSS
_ M
, N 64 b - APPROVAL OF CONSTRUCTED WORKS FOR
v 1 I / A° :4E FAMILY C9I
- T Date JAN 2'2 19935.Re No. /0 '''11)6' DaCal
0p ,s
_ O 996,7 `a 9-r3 JVQr•7 "3
Q N ...-ave • - The sewage disposal and water supply i!Ities at thla location have bees
O p + `�• /ST. FR.fzPS, gt inspected a Nor certified by illi:I or other agendas and found to.
V 00 `!tst , 1Z/33 v� O be anti FOR4 !UM OF SIrJR
`� U oo cAR GF,�'8- - a N T
•
L 4 • 99.6 o' .z, �t�a �':?.�xa,+,. 00F
A.
Chief
fik" } - ';- �. s®• i of We i:r end Waatevire.a Mmuasement _
\�. r - • 41 CO
•
", • W¢ Sr r 14_1 Wim'
CPn3 •' I
sit 1:' 0-
- t;o al .•. WF1L d °I
QOI sl' a''tt> Iz3-�t ' N a0 37a-io•.E DOi�lALD L. 1�1AL.r/1
Qin`' sg L A Iv CD -Ski FZv Est OR'
L u i b.D Pt/M� �Z 5h}A ..3 A V E •
�•C•!�< I S L / P, .-4. I I -7 5 t -`
�� n'� r vs' Sa -,,-I I$2� �A T i=E t.1 U r`l J O ' to
CLQ D1 /�J �cL � R.
o�• > FOlJn/.�A T,'PN G O CAT/o/v = C) /S /99So
�\ �SO+ t 1 tOE F/NAL /- B- 97 - f'.SE i.1tEte'r?,
�L�'V ' e` a:'' `:,, d{`+ - '*