HomeMy WebLinkAboutPerrone illi"�i;u�,
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F-71 IN, Town Hall, 53095 Main Road
`® ' P.O. Box 1179
� Southold New York 11971
Y ®� `s ,_,i." FAX(516)765-1823
JUDITH T.TERRY iiia 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. 1404-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PERRONE, JOHN
Mailing Address 1 P. O. BOX 1467
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 200 DEER PATH LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9596
Tax Map No. section 106.00 block 10 lot 26.002
Cross Street MILLER ROAD
Date Of Last Pump Out 4/00/87
Issue Date: 3/08/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.LLU. III II
•
OFFICE OF THE TOWN CLERK ♦, SVFFb(,'� l/ /
_ L
Town of Southold Q .. �_C�G� Application No. 1 l o
Judith T. Terry, Town Clerk Ea :
$10.00 - Residential 1�;\,
Town Hall, 53095 Main Road
p. 0. Box 1179 v' ZC YAW'•
:� . $25.00 - Non-Residential
Southold, New York 11971
Telephone 0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation
Permit No.
Fee $ )b•, b
DATE 3 - —io
OWNER NAME: • •
OWNER MAILING ADDRESS: p0 6 ›cit 64 7
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OWNER PROPERTY ADDRESS: r)—va io •
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• OWNER TELEPHONE NUMBER: 02 71 - ? 3'9' 6
TAX MAP NO. : Section /0 (c) Block td Lot c:).- tp.: °"
CROSS STREET: / 1.(��
TYPE OF. SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: , 6p/j / Y1 7
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.)
Signature of Applicant
RECEIVED B Y: '/ f JJ,A. ( �
i Town Clerk's f ice
DATE:
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SURVEY €O
THOMAS AMA/50A/ k
AT Md TT/TUC/t acT. 6,/978 _ ;.
G4TSEPT. 25,/978•
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TOWN OF Sour, 'o 4 '!SCALE: "= 50' -
/VOTE. :
SUFFOLK COUr4TY , NEW YORK t‘,1,0. : 78-597
if = hJ4,NC1M.&A/r -*UNAUTHORIZED ALTERATION OR ADDITION TO TH'S GU442d/4./7 ,c, 7' :
SURVEY IS A VIOLA1lEN OF SECTION 7203 CF THE C// M/c4/ Bdn/C
NEW YORK STATE EDUCATION LAW a
*COPIES OF THIS SURVEY NOT HEARING THE LAND USG/FE T/TLE /N.S ..c • CO.
SURVEYOR'S INKED SEA,_OR EMEOSSED SEAL SHALL SA(.TE OF Nk'�
NOT BE CONSIDERED TO DC A VALID TRUE COPY
X GUARANTEES INDICATED HEREON SHAD_ RUN ONL,'TO sgp,RD .p •)-0THE PERSON FOR WHOM THE SURVEY IS PREPARED •,
AND ON HIS BEHALF TO THE TITLE COMPANY GOVERN- �.� j'G P�
MENTAL AGENCY AND LENDING INSTITUTION LISTED
HEREON,AND TO THE AS:SIG,NEES OF THE LENDING t34 Z
INSTITUTION GUARANTEES ARE NO1 TRANSFERABLE 0
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
OWNERS
- *DISTANCES SHOWN HEREON FROM PROPERTY LINES •
TO EXISTING STRUCTURES ARE FOR A SPECIFIC l�C' 20
PURPOSE AND ARE NOT TO DC USED 10 ESTAGLISH yJ 45:93
PROPERTY LINES OR FOR THE ERECTION OF FENCES
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400 OSTRANDER
_7'4', YOUNG OU RIV RHEAD, NEW YRKUE
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'4'1< ALDEN W YOUNG,PROFESSIONAL ENGINEER
• ,,, A, :... • AND LAND SURVEYOR N'S LICENSE NO 12.845
HOWARD W.YOUNG,LAND SURVEYOR
• NY.S LICENSE NO.45893