HomeMy WebLinkAboutSchwartz Town Hall 53095 Main Road
P.O. Box 1179
s�, 0, 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. 1182-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SCHWARTZ, ROBERT J. & PATRICIA
Mailing Address 1 P. O. BOX 627
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1020 MANOR HILL LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-298-5058
Tax Map No. section 108.00 block 3 lot 13.008
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/30/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF, THE TOWN CLERK � tOtA' l l
Town of Southold Q C'� Application No. 6 1
/ /
`K c iii
t ' Ju6ith T. Terry, Town Clerk ;
Town Hall, 53095 Main Road • z !45% :G $10.00 =Residential
P. O. Box 1179 u' ',5--4f :' •7 `' $25.00 - Non-Residential
• �/ Jam„ 144 �
Southold, New York 11971 O00 ��
Telephone : j
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation a Permit No. '
• Fee $
DATE 04/./19°
OWNER NAME: Robert l lhr1`,0 /0a-- 0--
OWNER MAILING ADDRESS: /'o Cx
C.1dGIU� 9- N ( A
OWNER PROPERTY ADDRESS: ',O &.o 1\11Q,nO.r 1--k1.1 t-et v('
OWNER TELEPHONE NUMBER: @//6) act g s o S g ":„;
TAX MAP NO. : Section / (f �` BlockWs...Lot 1 2 ; 7 _
CROSS STREET: - " •
TYPE OF SYSTEM: Septic Tank New Existing r`
; •
Cesspool New Existing
Residential Non-Residential
'tr
DATE OF PREVIOUS PUMP-OUT: -;
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.)
iff
ign.ture of Applicant
u .
RECEIVED BY: ,
Town Clerk's Office
DATE:
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NOTE: . . REVISIONS YOUNG & YOUNG
■ -MONUMENT JULY/4,/977 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
ELEVATIONS ARE SHOWN THUS 32 0 - SEPT 26,19 7
NEAREST WATER MA/N 4 MILES f ALDEN W.YOUNG HOWARD W.YOUNG
WATER SERV/CE=PR/NATE WELLS MAY 4, /'9788 PROFESSIONAL ENGINEER AND LAND SURVEYOR
MAR 4,/98/ LAND SURVEYOR,N Y S LIC,N0,12845 N.Y S LIC NO.45893
• - SURVEY FOR:
UNAUTHORIZED ALTERATION OR ADDITION TO .
THISSURVEYOF HNEW A YORKVIOLATION E SECTION ROBERT J. SCHWARZ 8 PATRICIA A. SCHWARZ
LAW OF THE YORK STATE EDUCATION
`°W LOT 4 "MINOR SUBDIVISION OF WERNER
COPIES OF THIS SURVEY MAP NOT BEARING ,/' OF NEW Y
THE LAND SURVEYOR'S INKED SEAL OR 'l�/1N\UR,f-
EMBOSSED SEAL SHALL NOT BE CONSIDERED 1 ' O
TO BE A VALID TRUE COPY AT GUARANTEE; Tq.��'T L,I,-K '
CUTCHOGUE SOUTHOLD;my,,NG5 it 7r'" 0 d
GUARANTEES INDICATED HEREON SHALL RUN THE TITLE' {l,IHAW.t.EE1 D.,4. 0
ONLY CO THE PERSON FOR WHOM THE TOWN OF SOUTHOLD
I ,y�� -„SIN,°�S
SURVEY IS PREPARED,AND ON HIS BEHALF JOUT/IO D ,.. {'.�. `',,
TO THE TITLE COMPANY,GOVERNMENTAL BY S^ F'.i� :
AGENCY AND LENDING INSTITUTION LISTED I .:‘,2"..,•....!••'..'i 1 p
• HEREON.AND TO THE ASSIGNEES OF THE SUFFOLK CO., N.Y. ��,,��. t� ii �r
LENDING INSTITUTION GUARANTEES ARE
k'r O
. NOT TRANSFERABLE TO ADDITIONAL SCALE /::_WO' I DATE FEB 28,/977''"` �\Fs' w N-"
INSTITUTIONS OR SUBSEQUENT OWNERS rad/al jyf111EF•Q