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Home My WebLink AboutGurican G 000i0ii.,,,,, �,04 y - �`O '� . = z • W$ Town Hall, 53095 Main Road ,V" 41 �.�0 0' P.O. Box 1179 �°,�' _--__*/), Southold, New York 11971 JUDITH T.TERRY .', ,,/, FAX(516)765-1823 TOWN CLERK TELEPHONE(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. 1552-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner GURICAN, JERRY M. Mailing Address 1 HUNT, JAMES P. Mailing Address 2 470 WEST ROAD City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 470 WEST. ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-7133 40,00 Tax Map No. section 110.00 block 5 lot 4ci,000 Cross Street PEQUASH AVENUE Date Of Last Pump Out 0/00/84 Issue Date: 10/23/90 Judith T. Terry Southold Town Clerk (TOWN SEAL) t ' • OFFICE QF THE TOWN CLERK c�VFFRA- �� Tan of Southold � 1i . CQG_ Application No. / ' Judith T. Terry, Town Clerk Town Hall, 53095 Main Road $10.00 - Residential P. O. Box 1179 u' = ' ► �` $25.00 - Non-Residential Southold, New York 11971 OO Telephone _ .( At ', (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /p DATE Osa-i !'/J /9 90 'OWNER NAME: E/jrZY f7. UAi CI4 i `- -`471"/es' P. 4,u irr ' OWNER MAILING ADDRESS: 1170 ` 14lE,97 fgeeIb Cvre-yo fir' //934---,/5e/ OWNER PROPERTY ADDRESS: `/70 OWNER TELEPHONE NUMBER:- 67 6 - 73 $4-7/3-3 TAX MAP NO. : Section 1/0 Block Lot CROSS STREET: P u s►, H f}6/ TYPE OF, SYSTEM: 'Septic Tank New Existing Cesspool i " - New Existing Residential- V Non-Residential DATE OF .PREVIOUS 'PUMP-OUT: "? /9e51 8,A /g 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.) ✓ /� Sig ature of Applicant RECEIVED BY: - - Town Clerk's Office - . • . . =° � ) . ' � � . � ...:::i• � �~ �� ' | ' " . ` '. ______ �=� ^.�'_____'_ -----,-_•-•` __`___--_-_ __-________ ~� _______ _-_ -__ ��c�_�� ` -_��_�-�.+~ __- �-� ---- � . � � .` '-_--____--_ 1 - � . � --_ . � � �� _ �_� �� - Ii _- '_ --� ^ — - -- -'--- --- --- '— . . - - ' --_ _- ___ I________ _____ _-_- ___ .. ._ � - /.� - �| � - � + . _ \ _ , � -7 -- .// ` ' '--` , -'---------�---�---- -- - _ _ -- _ .-�'_ __ - _-___-_'__-_- �__---' . ' .� ._�-' ' '_— __-_--_'-__- -- _ -____-__-'_-__-__-_'_-- ' V^' ' ' ' /7 . '� . . ..� ' '--- --____.__ -_ ___-_ ____-_/ __-_-- ' � '-_-'-- _- _ ' _-___,— _ -__.-- _'_---_-_ _'___ --_' �-'_-.-__ _ -_ ____-�_—'_-__'__ . *� '-' __-- ' -_�-----_�---''_----' --- •• /�/�� . . � - -- ' 4770~--'�-^ ~^ -------------------- - � ' ' - - ---� -----�- - .C-ii. '' -~ u 6. ?-----� ---'----'-----------' - Z »n - . _- ' ____--'_-' _--'_ __ , ] - - -- `- _- - -._-- ~ � . ;LI -----' --' -----_----__ - ,--- - - - -- _ -__- ___-__--_'__--� - __-_-_-_-___- ' � - - _. - -__' '__ -_-_'--_ __' __---'__ _ __-__ -_ ' __ __ _________________ -__________ . � � ^ ` _---- - -- ^ _--..' _- --� - __ -_ -___ . | -_- . -. '- -_ -._-__' _-_-- _---_'_-_ _-_--,'_--'_--_-_---____- -_--_- _-- -_-__ -_-_.-'-- . `_ ' ' ' --_ .� _--- _ �� - _ ' ' ' ' -_ - - � � '- --__-� -- � � . � ^ � ) - -- - ' - _ ___'_~, -_-_--_-_-'- � _ ' ---_--'--__-___.__ -_ ._ '_ .' '_ / . -- - | '- -- - - � -- _- -_ �-__- ---�- _�-'--' __� __-_ _ ___ . -__- __-_--_.' . . - - ' _ - __' ' '_ ‘ ' . ._ - _. -_ _ .� __--' - - _ _ _ -- - - _, -_---- __----- - -_--_.-- ' - � ''`-_- - � -' -�-.-�- _ `' ' -_--- _ -_-__'___---_ __-_-'--_ - . ., ' - _ - - `' ' _ ,_ - _ -- ' . _ '--- _- ___-�-_ -_ -_' - -__' -' ._ ' - - - - - - --- - -- - -- -- ' ' - -- - -- - - - - - .. __ - . ' _-- -_ � -`-__.--' --'_ - . __' ' -- _- -- -__-'--__ _- - ' ' . . . .