HomeMy WebLinkAboutSambach 4.f COW
Gt.14
Town Hall, 53095 Main Road
s,grt `' P.O. Box 1179
®N. `•
Southold,New York 11971
JUDITH T.TERRY - ®1��`z°�'��/'_i!�II TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 900-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SAMBACH, LANI
Mailing Address 1 P. O. BOX 623
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 560 BAYVIEW ROAD
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-8854
Tax Map No. section 37.00 block 5 lot 1 .000
Cross Street DOGWOOD
Date Of Last Pump Out 0/00/00
Issue Date: 11/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
ii iii
OFFICE OF THE TOWN CLERK •S
OFFICE
Town of Southold , Y&% : ;_ CQG' Application No. 91.60Judith T. Terry, jown Clerk 3;' k- s •\
Town Hall, 53095 ainRoad • 7 Residential L/
P. O. Box 1179 _ 74 }r %;` Non-Residential
Southold, New York 11971 O' ' �`
Telephone - - - *14("0"...
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 961Z
Fee $ Dd
DATE iotas / e
•
- OWNER NAME: Lard l Sa, (y back
OWNER MAILING ADDRESS: (i):D jvx (, �
w a s t c,r 1 o s3 Nti ( ( S I
OWNER PROPERTY ADDRESS: 5 (.0 >0 ( f c...W "e_.
OWNER TELEPHONE. NUMBER: 1`s7 — '8 S Lf
TAX MAP NO. : Section 31 Block 5- Lot
CROSS STREET: D O C, L_obUc�
TYPE OF SYSTEM: Septic Tank New Existing
•
Cesspool OVe2 4Ob3 New Existing //---
Residential L./ Non-Residential
DATE OF PREVIOUS PUMP-OUT: ar 8g
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.)
CAALA.1
Signature of Applicant
RECEIVED BY: 4 hate -/
OP'own lerk' Office
DATE: ! / 4/
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r c f a��,� x�l ,, A MAP OF LAND-
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�, - N 37. �•7z NEW YORK
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i SCALA 3O t~ OF NEy, - tUARANTI?ED TO THE GUARANTEED TITLE
1� Y DIV_LSION — AMERICAN TITLE INSURANCE CO.
�, - 0 s 12.01.1 PIPE yPoi4C/ Vg4,�p�� AND THE SOUTHOLD SAVINGS BANK
4 IC '. ��..!S Gc t ' - --- SURVEYED AUG. 16, t96b
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-- NOW's -- s ti o - , VAN TUYLB1 SON
¢T NUMBERS SHOWA1 REFER TO. `MAP OF Cf
�c� tia " gry� ;;' r►.C_ T.2— GARDINER'S BAY ESTATES"FILED ysOtANDSJ� I.ICEI�I EO ,LANI,� SU2VE O•
-THE SUFFOLK COUNTY CLERR.'S OFFICZ ASAP tVUMBFsSL'' 2?S , _GR�ENPORT.NEW YO' K -