HomeMy WebLinkAboutRohr JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK T ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER _yQ �r et Fax (516) 765-1823
Itt.
Telephone (516) 765-1801
•r
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2080-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ROHR, WALTER J.
Mailing Address 1 P. O. BOX 1939
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 56863 MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2968
Tax Map No. section 63.00 block 3 lot 17.003
Cross Street TOWN HARBOR LANE
Date Of Last Pump Out 0/00/00
Issue Date: 3/19/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK •c„\\FFO/A-
Town of Southold ; Application No. 02 CFO-
Judith
8 YJudith T. Terry, Town Clerk • -� -
I $10.00 - Residential
Town Hall, 53095 Main Road c ,
P. O. Box 1179 C.T3 • _` : $25.00 - Non-Residential
Southold, New York 11971 _
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; oo
DATE -2//8 /93
OWNER NAME: LAA /Iev& c 1Q® 14 1Q -
OWNER MAILING ADDRESS: 00 /3 A. X93 9 cq'i h iD ,/Y
//q ? !
OWNER PROPERTY ADDRESS: 6 2 6 ,3 /444}N cQo
,SAO al-ha/‘P ly)(. //971
OWNER TELEPHONE NUMBER: 746-- Q 6?
TAX MAP NO. : Section v G 3 Block -3 Lot / 2 3
CROSS STREET: I; N wag } _A
.. TYPE OF SYSTEM: Septic Tank - -(7`- - 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.) Geo rr
/CV / "I Signat re of A licant
RECEIVED BY: W
wn Clerk's Office - - -
DATE: 3 // iFi ?.3
1
/ - - . .
�• =a' �1,� SUFFOLK CO. HEALTH DEPT. APPROV# k
_ \; C'-
•
`..� d:f:" H S NO ? 5l!-35 tLf,ay
__ ` `�y it A
.__- _SAP .ice rr=f E I 6 •.
` ' ` 5U.f-.vVF-''. -r) Fart , ,A') -�A;� ��C
- 1.(:). tLI-14-\\) . / i ---'r'.--s—
.'-' .' ' L E E. 1 \ 130\iv Ni E -)
_ .., _,..., 'Th *'`--.1,i --_,•
4,,\ / ''Z� S� �relor �F STATEMENT OF INTENT
CFS THE WATER SUPPLY AND SEWAGE DISPOSAL ,
- -•� f"� L..� ��•
-3c/3` �yf� , SYSTEMS FOR THIS RESIDENCE WILL i
TOWN. G_P ,out r f0LD, N,Y ���``, / ����' '1'� <. f CONFORM TO THE STANDARDS OF THE
( ��? �� / 3,;.7 . 9 SUFFOLK CO. DEPT OF HEALTH SERVICES.
O.,- ,t-\/L,t � APPLICANT
�`.. •—...YC'‘v / SUFFOLK COUNTY DEPT OF HEALTH
r ' V SERVICES — FOR APPROVAL OF
l /
CONSTRUCTION ONLY
•/' / ' / %
v +� / �- ! / DATE: i
/1)(9 /� H. S. REF. NO. a-•'.`_'r'_3
t - ' ' .
I
,
p.
APPROVED•
•
d e , SUFFOLK CO. TAX MAP DESIGNATION:
1. ///f • ��/' �r.}�o ; DIST. SECT BLOCK PCL.
/`/ -�:�2 �,,) ,<< I 6= B 17.3
_SCALE:- 2 _�� ! C� OWNERS ADDRESS:
DDRES
AIZEA'A? 4 :? 5,F',_CP MONUMENT pro_; i`:�,< i 21:06 -; E f_ -�i�R t�:
L' \ t 1 "14,..,!
_a=1)2Gf<i PIPE j '�� _
"Sx
��\�\• i Atb 1�i 7 �' �f / "- 1:-..)::-.1,_ :';
.h101'E /-.7---)Y0 ``?' ! 11-,-.1.,'5' q 1 \''6' ' '/ DEED: P. S "r `�:,_
• IZI�1-i2_�21<_ lo,Y_ 12.E Ec�v p PQQ / 1.' T�� <=�„2,•ii,� Ack-rop SUFFOI'I�COUAtTYDEPARTMENT OFHEALTH S TEST HOLE STAMP
P055/SL DEO 1-.CAT-1 �'I a / �` l<� / SINGLE FAMILY DWELLING ONLY ER11�f
\ �L i r /,•
�t.,�agio^ec a•�•4•rtt
r0
11
"G'''. S f:
- Tu-,mvs/N.- OF'SOU tH0L; F;-- O C-.. ,.•
��`. i �('`` DAT�Fr' 1 1 1987 H.S. REF. N 81-Sn- .._,,.�,L r 3 ��� :
`� sur=� Yn� e
ti_ / -nom! �,.0 1 L l _v,:�an s`X
"'� i4� R� a �L= �, tikes v ";f_ ,; , /�'1' The sewage disposal and water supply facilities for this �� —I Nr_,_ C; "••''' "`�' Q:�` ��
Z.C. __.__��, :� —L;�I' ()NI A �) h ` v location have been inspected by this Department and/or I I �=1.,-,.��r`"Q f u'��' .' kr°
MAP A ;�1)! a t i r.-2,40`510i�� '� ,'/ -J. ,) other i and +nil ,�sLv�- 1� ., ��
Y �� -3' 4 r LA. �•,4�.ati# .tory. ;_: E;' ,
i` t.Ac? EAST f�LAP�1Df� HOME .:;?, ; � / r C. _ LOA
;� ::i, �� -y
_. ._ _. . yk / / Chia:of Bureau of Wastewater Management `" c,.,.".7.:',..7:7-:.::":44::::,171,,,,Ftir.-71tet.'
..
a j til p/�� ep ) 4 ?,gin;fes• i a;�>^
t-i
N-,N
^,./ / MAC- AMEk,vEE_ MAY c_i�,RET vr,:Av _ • w ; ,• a..
..,.:!^inn
47
. AO Or \\rZAt :.ANP SEAL
,7• .:(7' '' --4,--‘4.-. \• '.i,v-\-p
' o `� , '7,,,„
0 t�� ::'t,ii2V YED FCC,IO,1987 I¢��2 4%0;1_ -• . �'' :'Q "� R®DERICK VAN TIJYL. P.C. �< �' ^ 1� '
•
R4.7.::0,-1, `ti - �j g SJR
- .^ .:7 . LICENSED LAND SURVEYORS •�•�L'�ANO.„--- •
• ., -• �N '_� GREENPORT NEW YORK
\ 1,
TELEDYNE AST N61239 1 — -