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JUDITH T.TERRY �� � � Town Hall, 53095 Main Road
TOWN CLERK y _ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
ViSouthold,New York 11971
MARRIAGE OFFICER •je ®•ie Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER ®l J11L 1 `,81.1 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3702-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner GREENE, JOHN
Mailing Address 1 1500 MOUNT BEULAH AVENUE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1500 MOUNT BEULAH AVENU7E
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-9267
Tax Map No. section 51 .00 block 3 lot 2.014
Cross Street SOUNDVIEW AVENUE
Issue Date: 10/16/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK %c5IFU(j- -
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Town, of Southold , � CQG=� Application No3 'O 2
Judith T. Terry, Town Clerk ,L(4( 1
Town Hall, 53095 Main Road ; $10.00 - Residential
p.,O. Box 1179 cry ' ► ;) $25.00 - Non-Residential
Southold, New York 11971 ��`
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Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL, DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE Iv g/ "/7-
OWNER NAME: Joh 6i(141C
OWNER MAILING ADDRESS: 15.0 LGfii'4
SO0,44-C2(-9
OWNER PROPERTY ADDRESS: /ADD 1147 &,14.14
OWNER TELEPHONE NUMBER: bi--'/u7
TAX MAP NO. : Section • 5/ Block 3 2 Lot .4
CROSS STREET: SOIGhiVety
TYPE OF SYSTEM: Septic Tank NewExisting
Cesspool New Existing
Residential Non-Residential
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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.)
Jai/
Signature of Applicant
RECEIVED BY: 1111 ' •
L
I own Clerk's Office
DATE: d /
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N/O/F BARBARA KOCH i
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JOHN:”.(11. `L�1ZA B:Tf1 JANE:. GREENS. ',j`f - =`
• . ' a • ;q ';.% b�' 'HOLD , ' ' - v .
' '.TOW"IV`OP SOUTHOLD
SU'FFO'LkC COUNTY, N. Y.
1000-51 03.—214
- Sea/e: 1"= 40' .
May 7, 1996
CERTIFIED TOS 4
JOHN GRTH E`LNfa..r
' • w ELIZABE -L .�- - - C.,. . •
ii
Soi Q�' ME t�i0,p i
AREA = 40,010 sq.ft o
=_ � , Fs
ANY ALTERATION•OIR ADDITION TO'TMIS S�{VEY 1S A VIOLATION /,` , •�,t, o- z
OF SECTION T209 OF DE NEW YORK STAT EDUCATION LAW, :�'
CEPT AS PER SECTION 7209-SUBDIVISION 2 ALL CERTiF1CAI70NS / �r °+ a' •�c� IC. NO. 49618
HsAID MAP EREON ARE VALD FOR THS AAP COPIES TIEREOF ONLY F' A L►1 ,,OATE�# SQL of TE SURVEYORwHosE GN ( A S WE PECON/C 7Flitr
1'-.C.
ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM•ALTERED BY' (5/6) 765 - 5020
P. 0. BOX 909
MUST BE USED BY ANY AND ALL SURVEYORS.UTRJZWNG A COPY
OF ANNgqTHER SURVEYOR'S MAP, YEWS SUCH AS" ECTED'AND -- 1230 TRAVELER STREET
BROUGHT--TO-DATE'ARE NOT AH COMPLIANCE WITH THE LAW. • SOUTHOLD, N.Y. 1/971 .
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