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HomeMy WebLinkAboutGoubeaud ° cf, �. Town Hall, 53095 Main Road ® ���'� P.O. Box 1179 - ®� ' 1�®•, Southold, New York 11971 JUDITH T.TERRY ----1,-,,,,,,0, TELEPHONE TOWN CLERK (516) 7654801 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. 743-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner GOUBEAUD, JOSEPH G. Mailing Address 1 P.O. BOX 66 Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 26340 MAIN ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-5208 Tax Map No. section 109. 00 block 4 lot 5 .000 Cross Street CROWN LAND ROAD Date Of Last Pump Out 8/00/85 Issue Date: 6/24/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK se SW Town of Southold CQ Application No. 7‘7{-3 Judith T. Terry, Town Clerk �� " , �; i► Residential Town Hall, 53095 Main Road Vet �i"�3 't P. O. Box 1179 � r� `� ► , Non-Residential Southold, New York 11971 L44 • S �O •�` Telephone •,( ' (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /''O DATE OWNER NAME: V (9s Gp%`J G---. OWNER MAILING ADDRESS: —pc d, 3 Ci.)( e,0`7-0_1-/-0G- E/ //93 OWNER PROPERTY ADDRESS: D= l' 3 SD .0 ' J/9-1 ✓1/ (�� vOCU.��, /L /19• 35 OWNER TELEPHONE NUMBER: c I6 — 73 4L_ c2 Oe TAX MAP NO. : Section / 0 7 Block " Lot CROSS STREET: c �- TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: 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.) C I /. Signature of Applicant RECEIVED BY: t_ (c,._ ,• Town //Clerk's Office RECEVED DATE: JUN 24 536 -- - • � . - - Tye- ••�'' - '-'.'t Z '" '.7 ?�'''`...0. ..-hfj t•,; ''' -'',5: <�' 'rtiCI 'f. ti. •'•�' , ' •• ' --- -�--�'_ -- ' � • ,• ..4"::.•;(4,tr.e" ,":j `«d,:_.y4yf.i}�i.'r r`:_ ` ,.t l..:, ' ''li''` r7 . ` •-: .,+-•,'• - s+' 7:Fa?-:''� f �', . ' ry • • e • ,,r {).y4 .:V !ti,e,.;{rti_a,.a V':y'-ii; h,y- r5s/c - ..• 'i ::,r-`�'. .t5`:_" '�_ h": %i1:-v',." P. c- . ;-9:x• ,.�i,,,<.f'Ls � ' - + • ' '> ',','7,1'"•:, - ,e. •,yar : :.-"' ,; �• ��.•, si.r1 °;L • ^ti- .x •� -. 51r. P�i'v:°7.'�vvi .�r�' .d;v•_4_ c_E..s.. c:l"am.l,[,•P,33-_..", . r <�=�'er> .s ' ' rrc,.,�.", '- -'r^ . , :>9 - �y/ I, ' / ,� �,/ f• - -s.•.jc.-•.. ` ' , + ..t:,.,--.•:-.",,,- [v':ya,-;_x _ .--Aiz' 't ,;.'-•rr; 7,IK. `„y;x' '4,•'.n'c' ;•'';_.- .7.',.-7,..,-/=,;-;:=,---..,_,i�g�i7_'ia.;__:f. e:'� • n"_F.,i-.., . ' 47 Z•�/' . • • _ - {, r,Ma - •ti ' `_ J ' _-, ' .; :,'•d4ri.�” rcti;;i',. uM � r J•" ' 3 ,S.*ayr ', •; ' 1L4',' 'T ,� - _ 'ti.a.pCr _ . !- fr-,......., r, iri1?Y- ` c.Ct a3, � 1sk:.. ' `4'.,rii., ....; '�. ,z: .i,Mry - . ' , �... .! .i _ cw i' : , , i ` • • • _j:._ k', - .�,. 'i! ri t,:�'=� - =v'� - '-b' 'ice ,iff.,.;'i; 4'ry "#^t1 CJ vt' - - :Y /., .. ,•fir. ^ r `, �s .t.. -•;_ : +l iy ''1-r'` *, - - '•.� _ " • _ ;�' •?, •"k r; .•i - :+ -': . \" --+,eH••,,:,.•,r- •v,{, , tea., •r ,- - ..v.• r-,, 1. .. , • ':L"i'li• . - -•2, ')• ^i'1 ,'�.� Z L,,,,,; .; --.----,•"!•••,- tee.' _,w s` - - ' _ - r r "�?�- �•r=•-r. !'', �`'• •. - _ _ _ - ' }i `•' � r '• 'J„ .L;✓ r --s`y1' - ..' -,t 1 _ `ice• `1f- 1 •J I�•t-r -1.6;'!C!•'=';:.' {�1'1�a 1- 1 ',,• �'�• _. _ *! ,.f'41),;,..., t��� r • ' •i a • _•a• t.. •- •• fir 'P - r,(=,11„'•'�� • • • L� "� t `L�• •q' •'�W,•••Y[• ,••1, a_i • . ••>� f- ,+ 1^ S' • 5•• ` tom`'J, •''-�k,, '3":'!..2-,::;••••,!_. , '1 yam' ' --• .1'. .t•• 4 r r.,,,,, ',../-....;.' �Y 't' t-_,, , -t Z, , r , ,. .. yc+ ` _ _ :�„ =,. i• ri .! ,.s'`rY. ''•,.,4.e~ `-r - _ .L., •'',...r.'„••7 a• �. /•: `S.• ''g•.T:• '-_` .,::•' ..'"':> •* - "?'rs� .`:! 1 y,al .1Y_' ' a:' ' • ? - , „ _t• ,j - • . 'j•rt Q '. -; N ,t- 4i 4,uat`. J7y •••t• �,. .Fi c`.'"'.:`;:-.•;, ._ _ •'p:^ _ ,• - ""-1 ''�! '.,`�.. '�'\ i•/ d �>-'• :Y. a,.•1!..4.1,.-;,•,),, =4 t .i ��L: _ V,,, =" .j., >..�� 5,.:_ - ! '•t •t� _ ` • • r'-• - 5 5 , C• - _Ln L- - - ,-,, ' , , . -. ` - _ " . ;StJR.Ve.i!ED FQR, r • irk �•�tY n r;i' • i o- >. S( d • ! 41- • • -y, '!•>`i�r}'�' ,` �,••it+.• _. • .7'� '•>^ {Y• • ,> S.E• �i'�c+' . 4116vi��r •?W1.�y5r\i. '4a[: -..N .X¢._�•'� •LCL- •yr-,L is: -fes }. a;,y c�. •J , - •I;, �•. . }\ryy..La. a ,� �'„C.; , +4. -"« �, .'i'. :l,''a• :r�3 •�:. .l•.y 'o('• - '1 _ l' _ 1i- u_{ \r.•fr71../�+,. 7.�.. - : '- ,. _. , •{ ,.3'i