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HomeMy WebLinkAboutSchlereth 11,10101.0_, 1,10 f q.'I,2Y.t`2 ,d°1� Ler Town Hall 53095 Main Road /!' P.O. Box 1179 -4-756 I��,i!' Southold, New York 11971 JUDITH T.TERRY „��� i� FAX(516)765-1823 TOWN CLERK TELEPHONE(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. 944-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner SCHLERETH, JOHN C. Mailing Address 1 42-43 161ST STREET Mailing Address 2 City St Zip FLUSHING NY T1358-0000 Property Address 1 805 BAY AVENUE Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 718-358-7535 Tax Map No. section 143.00 block 4 lot 24.000 Cross Street EAST LEGION AND RILEY AVENUES Date Of Last Pump Out 0/00/86 Issue Date: 12/07/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) = .. OFFICE OF THE TOWN CLERK I,�FFOCQG' 9/9' = _ Town of Southold � , Application No. Judith T. Terry, Town Clerk Town Hall 53095 Main Road Residential P. O. Box 1179u-3 � ;' Non-Residential Southold, New York 11971 O ®. �•( Telephone 44'.(.41%.0 (516) 765-1801 TOWN OF SOUTHOLD EaCinD NOV 2 5 SOO SOUTHOLD WASTEWATER DISPOSAL DISTRICT IND � APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ - DATE CC--- OWNER NAME: 0--4; (-E&f C. Sc-14-LE R. a 774 OWNER MAILING ADDRESS: - `Z' 3 ( 6 l s F7� V S 14- N. y ( ( 3 S OWNER PROPERTY ADDRESS: 8©5 -6/11 /ti AT, rfvcrit ( OWNER TELEPHONE NUMBE-R: 7 ( 8'— 3s; - '7 s- 3 1 �f /� _ TAX MAP NO. : Section Block Lot CROSS STREET: 15e,re..e, t,tn-‘ TYPE OF SYSTEM: Septic Tank New Existing Cesspool V- New Existing Residential V Non-Residential DATE OF PREVIOUS PUMP-OUT: C /?d'G 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 .fi"Applicant RECEIVED BY: &i, tkz tice n C rk's Off ce DATE: DEO 7 X358 Inv OW SOW peters Isle 250 00 c— E o OCZ -4 N co Na O O O O .1 \ n a _ n 0TIN co 0o3I,QO E °' fgar- o -� \ -= ch .lak°'g� : B , �I � �o�v 250.00 el �t ZO s{�r�ho°se, ___--------c-. , Z h01d RI ey 1 / 319 ,— {rot \ 1 TOO f 500 ' a nD 186 \ o 11W LOI NO. % I1 G , W file i O JB 3' - �\ 1 00 f, O ,31 O�, 5.10 Oil" \ REVISIONS YOUNG & YOUNG - reh sV 400 OSTRANDER AVENUE, RIVERHEAD, NEV:: YORK ,1 <rn \ P K ALDEN W. YOUNG HOWARD W.YOUNG 4 1 ` \ PROFESSIONAL ENGINEER AND LANL`4 SURVEYOR C Z . LAND SURVEYOR. N Y.S. LIC. NO, 12645 N.Y.f LIC. NO. 45093 ` C NVI 0 SURVEY FOR: _ N c5 JOHN Ic SCHL ERET H � E AVE N AT MATT/TUCK GUARANTEED TO: Y GUARANTEED TITLED/VISION OF R I E TOWN OF SOU T HOL D ' AMER/CAN TITLE INSURANCE CQ NOTE: MONUMENT SUFFOLK CO., N.Y. Byilisavet,jam, SCALE: / II c 401 DATE:JUL. 29, /97/ NO. '7/-440