HomeMy WebLinkAboutRoss (2) RircortiN
t, a Town Hall, 53095 Main Road
P.O. Box 1179
�j �� t Southold, New York 11971
JUDITH T.TERRY �� !!' TELEPHONE
TOWN CLERK ��� (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERIC
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK, or CESSPOOL
Operation Permit No. 832-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner ROSS, ELAINE
Mailing Address 1 PLEET, JACQUELINE
Mailing Address 2 P. O. BOX i78
City St Zip MATTITUCK NY 11952-0000
Property Address 1 50 VILLAGE LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9585
Tax Map No. section 115. 00 block 1 lot 2. 000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/14/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 'c3vFFO(,( ""
Town of Southold Q C'� = Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ..v"4. w _G Residential p
P. O. Box 1179 Er, Tspaf, Non-Residential
Southold, New York 11971 ` 0` •4`
Telephone Q( `AC �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
.Ja
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. P32'
Fee $ /D
DATE ch6•;jfkg
OWNER NAME: eca;n412 o-5 /ilr- 5 CI(1)6'' pt
OWNER MAILING ADDRESS: p. 1, 6D f�� V
Mce-ia-vft-L ie .
OWNER PROPERTY ADDRESS: (LCp?,e_. LO /,2 p
(A 4-c-)CJ �. (tO . // 9 c
OWNER TELEPHONE NUMBER: 02 ),(Sr �$
TAX MAP NO. : Section Zi5 Block Lot
CROSS STREET: D t LL - 1. i0e. / i2s'„15 l /(JC2ljC,e.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing t�
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: t(,ll�l R
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.)
a -
Signature of Applicant
RECEIVED BY: C K-®1pc.
RETEr.y-Town C rk's Of ce
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DATE: s:e 7 a r, •;•
s .._ ,` .-,' .. F . 8/08-085628 • -
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's01V�s MAN • 3669 ' ® j. ,
, Su AGE NO p 0-.. *per
, ' V 11-17 ' 'FtI7e 8o- •\ , • - , `
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` ,Unauthorized alteration or addition to this survey's eviola- • m 8G 0• n 5
tion of section 7209 of the New York State Education Law. — . ' \ - ,C lr
Copies of this survey map not bearing the land surveyor's " p G
inked seal or embossed•seal shall not be considered to be a • \ - R ,,I A�
valid copy. `� App'YI' Yf 5 ' 'GN VY
Guarantees or certifications indicated hereon shall run only • o q2, 1 N
to the person for whom the survey is prepared,and on his Cld 5 63 p 5
behalf to the title company,•governmental agency and len- ` Q Q 1" i1 N G
cling institution listed hereon,and to the assignees of the - f� -
lending institution: Guarantees or certifications are not / ' 1� 1N / A
transferable to additional institutions or subsequentowners. - 1^ ^ / '
1000- 115- 01- 02 --,
SURVEY FOR , -
REFERENCE+
ELAINE ROSS, 8 JACQUELINE PLEET ,
AT MATT/TUCK"
TOWN OF SOUTHOLD '.� - 1.\ - GUARANTEED TO;
SUFFOLK ' COUNTY N.Y. " 4'0 051 A, /'i,-rid CHICAGO TITLE INSURANCE COMPANY
11 ELAINE ROSS 8 JACQUEL INE PLEET
SCALE : , 1"30' i* ' , X,{"..
JULY 30, 19 81 'r �II :w •` fr
,T- II
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�0ti �S 2812c 44, _,&� .. - ' y-- . '
�Q� LAND SURVEYOR
��0LAND G.) N.YS. LIC.N0.287E8
Ff1YElfHEdO, N.Y.