HomeMy WebLinkAboutGaynor OFFICE OF THE TOWN CLERK • 'OF OC1(i-
Town of Southold ��
Judith T. Terry, Town Clerk • � `
Town Hall, 53095 Main Road c ).
WOV
P. O. Box 1179 '• , ,�
Southold, New York 11971 ® ;;y
Telephone , d
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 467 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Mark P. and Ann M. Gaynor
OWNER MAILING ADDRESS: 1905 Marlene Lane
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: 1905 Marlene Lane
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-9531
TAX MAP NO. : Section 144 Block 3 Lot to
CROSS STREET: Peconic Bay Blvd.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown - Owned since 6-81
Judith T. T % ' y
Southold Town Clerk
DATE: October 19, 1987
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK .*TFU Jj '
Town of Southold - CQ ' Application No. X67
Judith T. Terry, Town- Clerk ►
� , , Residential
Town Hall, 53095 Main Road 4 >�
P. O. Box 1179 CS) ' �' - Non-Residential
Southold, New York 11971 O-44-4,161-0-1� O�'1`�
Telephone .( 1
(516). 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ / -
p
DATE f0 / ,j v
OWNER NAME: P I fti Il P. ,Fr,4b A--,/A/ M 6-0P" yN e
OWNER MAILING ADDRESS: / 90 5-- �'I .££ t E
OWNER PROPERTY ADDRESS: S14-7-
OWNER TELEPHONE NUMBER: J p -
TAX MAP NO. : Section / / q Block 3 Lot /
CROSS STREET: E C 0,q/ /C 6 4- y 4 4_ V_6
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential 1,/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: l9G/KA/C•W/T./ - ®bdifirE..6 5AJcE G�,l
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.)
Signatur- of A./'icant
RECEIVED BY:
Town Clerk's Office
DATE:
SURVEYED FOR:-/7. ,,0'eZ rc,' ,4AJAJ /1-7,4,2/E G.43iit./O•e
LOCATED AT M4 7-7-/TG/C ' , TOWN OF SOUTNO4D , SUFFOLK COUNTY N.Y.
LOT
MAP OF L..)E'..SC.F/BEI0 P.EOA='�"-eTY , CO. CLK. NO. FILED
SCALE 1" = .... e." 1 N/F �,4ME5 C-.0,e,e/G.��
SUFFOLK CO. TAX MAP DATA:- „�
/t/ . .°‘21--1"'..5-:" --r,_,_54-,441/.41
meg�o"5c �D. I
DIST. /OOO , SEC. /44.00 *+� ---�
4-.'/a/N G/A/)�' 45-. ./°"-.5
FFa/CE
BLK. 0.300 LOT O/0.CCC �-+S
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SURVEYED /l/!®Y 26, aa 1981 BY
WILLIAM R. SIMMONS JR.
P/O BOX 377
JAMESPORT, L. I., N. Y. 11947
'/ a/ e ;� �., FILE NO./4.4f.,4, _ PAGE 23 - GRID 4 -.37 .
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DRAWN BY - _ _