HomeMy WebLinkAboutRowsom (2) X11/I//�iiii
i°eltfOLA
JUDITH T. TERRY .'SATown Hall, 53095 Main'Road
TOWN CLERK ® T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � �� Southold, New York 11971
MARRIAGE OFFICER
Fax (516) 765-1823
-w®4 , or Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3168-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner ROWSOM, GEORGE H.
Mailing Address 1 PRICE, WILLIAM H., JR.
Mailing Address 2 102 MAIN STREET
City St Zip GREENPORT NY 11944-0000
Property Address 1 360 BAY AVENUE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 415-477-1990
Tax Map No. section 31 .00 block 8 lot 7.000
Cross Street MAIN ROAD
Issue Date: 2/04/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
r'1 ,
•
S „,OFFICE OF THE TOWN CLERK c.31
Town
Town of Southold � CQ ' Application No. /62J')
Judith T. Terry, Town Clerk G
Town Hall, 53095 Main Road _ 1 7 $10.00 - Residential
P. O. Box 1179 u' 1 rte ; $25.00 - Non-Residential
Southold, New York 11971
Telephone I414 ��� '�•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0( 0)
DATE I ((v4(5,4'
OWNER NAME: e r'f ' ' R . -A- 15'1' �'�/u-.�
OWNER MAILING ADDRESS: (OL 1/1,cj Sf
G'-reevi, f, -1/(i
OWNER PROPERTY ADDRESS: '3(o Co 1
Ii - I , 62 • 11t39
OWNER TELEPHONE NUMBER: (5f1.) \i`7 7- 1 ql q o
x-/73 s, 3 /. — 7 '
TAX MAP NO. : Section Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential X Non-Residential
•
DATE OF PREVIOUS PUMP-OUT: Ie e.
•
. 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 :-:.ad.)
•ignature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
1
a-A1 . ,/ 1
D.
'JJ
I
' " aro
r• N -I' r _ 1_-o.o
N
,� 0
/ 1 - 0+0,-,/ f(�� r „nal, ��
Fel () t. J
fr. 11outse .•a
/1:i ' 1)
0\ I I
;! •1. i Q
0 , I�orch 1'1
in 0\
—
(SI III
/// V-N. :`• ,,,,,`--..
--.1�C
Iii,,,-..
,7 .
L1d�� ctlnfl ,, -150.0 I C o
in
_ ?i
`'
/
f
11.,
•
-- .I
-49.5--- -
At) f-foxi Kret-
•
I
1O/
C—Q) .2-7 ..
•
(V1,•1-1 r:= C r::: P?OPS 2=2--n.,
i :va ��/'r:10 Ful:
_Jai-4l\ J 1; ! f� ' i -IL:IJ 1 1�-'� / li �'• -7 _-/'1
H T f✓1i=+(-1oN
Towry 0E-' Ec JTHUL D, N.Y.
(JNAUTHOKIZED ALTERATION OR ADOITIOn
.0 THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF THE NEW YORK STATE
cDUCATION LAW.
:OPIES OF THIS SURVEY MAP NOT BEARING
.HE LAND SURVEYOR'S II.LC:D SEAL OR •
)r 4IOSSED SEAL SHALL NO1 Br CONSIOCUO
;0 RE A VALID TRUE COPY.
5-C_cafe : - IF: T+k :Vo. `::.2)-,,-ac.:)( ?(
C'JARANTEES INDICATED HEREON SHALL RUN
O - it-of( 1Jipe G•NLY TO THE PEPSO•I FOR WHOM THE SEIFVI
1;PREPARED, ANO ON HIS BEHALF TO THE _ L J
TITLE COMPANY,GOVLPN,+,ENTAL AGENCY i_(JCE)'IY71-1 -c.:�,T +o 1' (l: o1/Irf j c id +G '
LENDING INSTITUIIG,•1 LISTED HEREON,'ANT ,
10 THE ASSIGNEES OF FHE LENDING :E'er-if-rPT; (f f"1e -k GJ,arri vrf4 COttt Ctt?J •
1'JTION.GUARANTEES All NOT TRANSPFIA '' J J
:::;$ SJJrv�Gicli Se >`.8, �-::
198
FO ADDITIONAL IN5T7YIrTini.A OR SUNNI. .
OWNEkS.
I- CC.E=z:-;lc1, lir-.4N -iuY1._, t-
,r __ -
�.:, 1/1� /.-,..--, .2- L
:'� a(1c; i,_1JUf T1�/ tc!:{ :1 y�} �L�'2.iC f T717Uf7: - '` '
J ra ''I LI:_L'f7: :..'C( Laud .?(Jrvz:((on; •
• 0(5+. 100[, Sec,-r:Gas! , hlL. 8, f2?-.1. 7. u(<<E:i Ii.,'ar---E- -- t•.�.w `-1-4-1,-: ,