HomeMy WebLinkAboutShaefer L•
00'cz,stf
•
Town Hall, 53095 Main Road
P.O. Box 1179
_ ® �^ 4* Southold, New York 11971
JUDITH T.TERRY �, FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 1258-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SHAEFER, JOHN R.
Mailing Address 1 SERVEN, MARY N.
Mailing Address 2 P. O. BOX 658
City St Zip MATTITUCK NY 11952-0000
Property Address 1 155 DELMAR DRIVE
Property Address 2
City St Zip LAUREL NY 11958-0000
Owner Telephone No. 516-298-5004
Tax Map No. section 128.00 block 3 lot 8.000
Cross Street PECONIC BAY BOULEVARD
Date Of Last Pump Out 0/00/00
Issue Date: 10/03/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c��FFD(,�
Town of Southold oc51 _+v l'��'•, Application No.,
Judith T. Terry, Town Clerk ),, r y
Town Hall, 53095 Main Road' =;fir $10.00 - Residential
P, O. Box 1179 �'' tri
$25.00 - Non-Residential
Southold, New York 11971
Telephone ®j 41 7%
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE i /3 .i3
OWNER NAME: J0/1f/ ft 51110) 6.6eT- 4- p'My pi seRvE,v •
OWNER MAILING ADDRESS: Pt913 66-£3 Mill—Tire/ex /`/ y ill 51-
OWNER
2OWNER PROPERTY ADDRESS: /5 5 4-1-G/"/4 R g7ILlus _
v R E (-
OWNER TELEPHONE NUMBER: 5- er S — 5-® ® Si
TAX MAP NO. : Section / .. 8 Block Lot g
CROSS STREET: pace: wiG O,¢ Li $oV51.. fih29
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing ��
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
rs
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
/4;r41.A„,
Signature of Applican
RECEIVED BY:
Town Clerk's Office
DATE:
r_-1. + ,
i .
. I
2 200 00 v, D I.
Lit ,
1% O
,20�IE ~� i I,
1; �. Rl
,06 �� /` a �
\ N' „
?72, _ CO 3e p_
•
t0 O Ic.. �'• — a- `I
HCl ° lY (-- . ��.. f. ',` —�....5!..'':- t
J1,i
aCO o : h,'+`�Ves 051 �\\Z
2'0 0 —
0
D av w \--TA
CI ' CO o�p
dw \
, , .,. 'r.,,ii0,14119 `-- ' .' -:' , , , \ 2 , ,
P, merly
./ o�. for 1
no" R-7.5548'
•
L=46.97' 1
z.,
fe
CD
NOTE: , /(/
:MONUMENT
51/80/VISION NAP FILED /N THE OFF/CE OV
OF•THE CLERK OF SUFFOLK COUNTY ON
✓UNE 22, /970 AS NAP M0. S486. 'I
• i
oaf NEW Fo
F1` Y V.
, 1'13'.- ' ILJII.t.;:;zi.:.:c;-‘13,... - ‘ ; -• . .
_._, y�fs, tip,yE.07:724?
Ab 1•�O`` ':�:� 1 �, - -
•
--Y' REVISIONS YOUNG & YOUNG
- - .UNE /, /978 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK '
ALDEN W YOUNG HOWARD W. YOUNG'
PROFESSIONAL LNO NEER AND _ ,LAND gURVEYOR ,
- - LAND SURVEYOR, N Y 5 LIC N0, 12845 "N Y S. LIC NO 458S.1
VPAUTHOIITED ALTTRATION Olt ADDITION --
TO IMIS SVP.vo• IS A VIOLATION Of SURVEY FOR: 44/4N P. 5/.1 6Fa-K — /I4.111_+$ at 5a0..vc3N -
SICTION 7209 01 THE NEW YOILK STAR A �T.0 _ RVGHW I S 4l R EI /� OV/+� ��..n
WuCATION LAW. V �••v '� `-^ `/'t '�� "' ,
COPIIS Of IMIS SVIVEY MAP NCT RARING LOT I 'I LAUREL COUNTRY ESTATES " '
Int LAnD Su"V,t0.'S mrEC SIAL OR
EMbJSSED VA.. SnALL NO1 Si CGNSlDERD '
10 51 A YAUC 1,Ui COPT. , ,
GUARANTEES INDICAIID F.:4:0N SHALL RUN IAT - GUARANTEED TO
ONLY TO Int ?MON 1O2 +...OM Int S..:vtY -LAUREL ,. CHICAGO TITLE INSURANCE CO.
IS PREPAIfD, AND ON MIS .HALF 13 In: SOUTHOLD SAVINGS BANK
mu COMPANY, GOVERhMEN1AL AG:•.CY ANC TOWN OF
LANCING INSTITUTION TESTED MIREON, AND SOU T H O L D
10 IME ASSIGr+IES Cf TMl LINDL9G INSTI• __
SUFFOLK CO., N. Y. S r
Tui10N. GUARANTEES ARE h01 T0.ANSf(/lAblE �/ i// //,///
10 ADDITIONAL INSTITUTIONS Oft SUftSIQuENT •�v'/Ye-/Yl
O rNaS' - •• SCALE: 1+ I DATE: , NO. • ' it —
I : 40 MAY 16, 1978 ' r 78 - 272