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ir tea If Town Hall, 53095 Main Road JUDITH T. TERRY TOWN CLERK c ® , Fri �. P.O. Box 1179 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS p�® ���' Fax (516) 765-1823 MARRIAGE OFFICER 40 �® of Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER 7® 4� FREEDOM OF INFORMATION OFFICER l OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3239-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner ROSS, RONALD AND ROSA Mailing Address 1 BOX 738 Mailing Address 2 City St Zip EAST MARION NY 11939-0000 Property Address 1 1005 CEDAR LANE Property Address 2 City St Zip EAST MARION NY 11939-0000 Owner Telephone No. 516-477-1355 Tax Map No. section 31 .00 block 6 lot 29.000 Cross Street MAIN ROAD Issue Date: 8/16/94 Judith T. Terry Southold Town Clerk (TOWN SEAL) • OFFICE OF THE TOWN CLERK cl\FFD(,�I Town of Southold � ��G� Application No. 3a 3X Judith T. Terry, Town Clerk Town Hall, 53095 Main Road � ..G`1 $10.00 - Residential in r ii' ' P. O. Box 1179 ':�:�� � $�� �i � 25.00 - Non-Residential Southold, New York 11971 Telephone 6..0,( { (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for • OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ (04 / DATE F/i 0 l�! OWNER NAME: !2/V4-cr,j) /2e' -CS7/26-54- S OWNER MAILING ADDRESS: (&-C L.C` J � 61/kf i c el 4-A.4&•J Ay It q3? OWNER PROPERTY ADDRESS: C- -EZ lis s7— t1 -a( 9.J A-J-4 t/ 3 7 OWNER TELEPHONE NUMBER: C31 ) X77- l3 S'-r- &--/.1-) S-06-1- 06e-3 TAX MAP NO. : Section 3 / Block b Lot CROSS STREET: !� / ,,E1 T /Y4-/2,/ D ki TYPE OF SYSTEM: Septic Tank / New Existing Cesspool t/ New Existing Residential Non-Residential 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.) ignature of Applicant RECEIVED BY: Town Clerk's Office DATE: _._ • a, ;,-:•-' • CIS. 11-wo.-hor.,:a4 ahegat,0a,ar ttcHif.tal - ,, .- . , Offai<A C.S . 1 , z Set..^..4 7.203 ot rho New Walt.Shz* .\ .. - ..vity--:( .- , rdue.:01.-..1 ngiVat i,:i t+ .." - Co Q.,cf T:.19 StITV*Pl MA',-Aot toaiinA --. -, the ...c.,,..w's...,,..0o sate,ci f /- cas,....Ail!nt.1 pa crAre‘Auff r.,,.•,--- I--s-.,..;:d true capi, - _ . - / r3.40-E..ares..5 triAcataheAnore slyin tun "?.. .-•- - - w.c,/-70.Ia CUIS(3.',kg-wham it'll,SOME*. t"--) - b.s.h4.1f to the .. ..1 .• . . . . . . h•-• camr..,-.•/.pavAranwarJ WM`,Cor4. V) ' - • / ..A.-,.f.ste...tic.r.U.sie.5 tiri:Gna to-4 - f'.\.. - _ - .. . - . - A • ro nst•.2.,,..stfir,..F.a.s-Gltha taa-cen inati- . l' ' - - - _ 111.xm.-GuirEtritaar.a rkraat trAlsionthiA - _e. to,.-,c.cf:Ana)mutt:UW*3 er shin9VIAAA • ... , 4, _ _ . . awnea, ' e - -• : _, - V - . . ., . - - . . _ - ' . ., . . - • . - . • , • . - . ,.. .,... • - , t .., 21V I',937_. . . . x Aeni Se, . . • ._ • - • . ',,, t":* '7/ -- . ' , . ' •rei?'. . N4 , 4.?r ,12N.Y . , - z ..../ _ . . le...A1 wri N- 64 — --------k--",-- • ..,, , •..: ...: Iv. 0--- . -.a*.4,‘--_, 1:--- -..'- ..'lf.;• --- -3-, ...'-- ‘,..;,. , ...-./'L 4'2-:- '-.-- - ,' ,, , ...:-. u'51.- :: i- Ai.-- - ) ,r.4-- .. _ _ _,...-,-_,2,... t k....... -..' . - . • ,.-,_ , ,,.•, . . s,, ,• ...... ' vsa (.,..,...„,i,., ... . . ••,;: 4-4- . ,,--. 3, •.3' "... _ 5 6/h:---,r-- • I is, -• • - :',-/-.4••-•"-z.-- I- _ - - A-, .- •--.. • • <- • - - _ i - • . _ te... _ br)\ . . I- ., ...,-) . . , ace/ ,,--- _ . Sc • - 1 MAP:-• •F- - - _ - - , ---5-- -- - S.— ._ _ 1 . - _ __