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HomeMy WebLinkAboutRubin • .� - •111oFFO` r •0 �� •t® OG . JUDITH T.TERRY ��_ yet: Town Hall, 53095 Main Road TOWN CLERK ; y P.O. Box 1179 i Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Vel �� �� Fax(516) 765-1823 MARRIAGE OFFICER , /f' ®•i RECORDS MANAGEMENT OFFICER : ®•( � *��116 Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER ..0' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3508-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner RUBIN, LAWRENCE AND VIRGINIA Mailing Address 1 C/O DBM CO. Mailing Address 2 P. O. BOX 2130 City St Zip GREENPORT NY 11944-0000 Property Address 1 1805 JOCKEY CREEK DRIVE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-477-2223 Tax Map No. section 70.00 block 2 lot 26.002 Cross Street OAKLAWN AVENUE Issue Date: 8/29/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) ago " "...� OFFICE OF THE TOWN CLERK cOF air Town of Southold Application No. 3 08 Judith T. Terry, Town Clerk Town Hall, 53095 Main Road - $10.00 - Residential P. O. Box 1179 til �� $25.00 - Non-Residential Southold, New York 11971 �,y� Vf0 1114 Telephone _ (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE 8.-021 - �P6 OWNER NAME: LAco/eEAM-6-. •v- L/i ,ec7 /.0i4 Rv3 //L.) ` OWNER MAILING ADDRESS: C f�L1� t7 Li ►-1 Cc, PO 0,L 0 G,e �AJPOvf % f (9,15( OWNER PROPERTY ADDRESS: z ps ocKt.V L ck D/2. S0 T1+ova IL) `` c19 -1( O TELEPHONE NUMBER: 5 I ( - Li -7 -7 - Z3 TAX MAP NO. : Section "7 0 Block 2_ Lot Z G. •2_. CROSS STREET: ©A f L/4- o3A) A U6. . TYPE OF SYSTEM: Septic Tank _New ✓ Existing Cesspool New Existing Residential -k/ Non-Residential LOCATION MAP: Must be attached hereto before permit may be issued. (Locate building and system; give north arrow and feet /1 ,,,, sof distance, approximately, to building and closest road.) �/�' A q If Signa ure of Applicant RECEIVED BY: Town Clerk's Office DATE: -..: �:..,,n 1':`Y. .,,` - . r .. r - .F:.'� - ,•'t•---. ',- -,,.'�5 I rt �'i° `°'rS�)�j t„_ '.;c:.•:'..:-:-...-.::','4:- _ 1 - --,,,•-••=::::.?„___ .i T. - .i,.: _ � wad,-% _ ,r�r - �r' v tY • F - 1, KC s _ vz< F �,' 'J° - 4Jv J ,i- - )•_ > ' <b;, _. 7f4T' ±i. -Tt„”i. .i, .�. •., - .. ai. } ��t,.�{.�;aN�. -JS::� •' _'.'v.,f,y��. JAN t'•1995 • • :Mrd-?' "� ;' �• TY” -..,,,- .'„,-;,,•••-;'•••7;;-`,,P,,. • C� \ moi• r.b*.. r,• ' ,: • 'UNION' V - ,gay ' • ' \ •• THE WA7EFi SUPPLY/l15ID SEyV}�G 'pISPOg' DIST S \ \ PFO[_.J6 COLI V'7'v, .y. SYSTEMS ' FOR •THIS RESIDENCE 1Nlt- �Y°cchf) \ " \ O + CONFORM TO THE 'STANDARDS OF THF, ~ / „NfE $TALEE Leg .A _ �+g;y 5-L /} SUFFOLK CO. DEPT OF HEALTH SERVICES. IQJCI2 N. Q \ ti�'6x \ \ \`iO�1�'i7�Ji ES1iEL� VF ii.Q�' s r ( (Si �~�`� 60 62 r �_ \ 9 \ SceylG: SO !” APPLICANT I � ` l' L+ \� Arsa= 31,-536 s1.f•F + SUFFOLK COUNTY DEPT. OF -HEALTH �`Q J n n =-t*iOhurrtgtri SER VICES - FOR APPROVAL FOR 6. % \ \ CONSTRUCTION ONLY FEBO. C �// �� DATE. C 28 V \ N ..... , ,. p' i /sJ �, cessAoof ..) ti. I 1• \ `: \ �' \ SUFFOLK CO TAX MAP DESIGNATION: 1 % \ . 5.82'32E- \ 3 L Al?tvf .l. 507,ex �� -- a. \ i I DIST SECT BLOCK PCL.. l a `14, \i �. — • / a ._ (000 070 2 26_2 l a ,L , \ r- OWNERS ADDRESS frame �\-.1 p �S` �fes-1 hole.�0. \��/' l?� �; 0 N 6 6ettwsi Si-. `h \� 'i \ \ 1 0 �� ' Comrrtac14,,.1�r_Y. !1725 tN- 1 =� �� o / 1 (T493473) * � t� % �° N Prot%house +; 6i v DEED L. P. N ___ �_ TEST HOLE STAMP linea i N 19I15 dtlrk .well we(!�\s•. i ' ( - _ loam l N.-77'46.50"W. - 220.0 "`-___ S- ------------------ ��~ \--- silty ^,o I 4 ,-,.--150'---___\ ��i loam 2 Is JOCBEY Ce EEK } p�t� \ ` - i 1e ' '; 1 brown 1 '1 I \ fine -h? f1 — 1 —IS— \- t�ubtj4 t�.) \ Coarse well th N - I( ' t t' j scrnd SEAL / ^O well , V >< r` %yO ` ,a :: Guorcttt Feed �o,Frq/BrJjf Na �otral -----__?f- +\°' 0 r. x Ti41a /rrZLIee rtc"_•Cq Sail pnd ILO cjrotJrld #e owric r,d•.S•triry a41-:%arr_2T,/995_ wafer �. o RWEtjICK VAN•T(JYL.P.C. Cesspoo4 E',, dafum:,rrrerrtr, sea l�vvel,nIGVp. l _ . Premises in flood Zarres•C.-, cesspool ",+ i- ED LAND SURVEYORS t7 --- ---- 1 ------ ----- GREENPORT NEW YORK