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Home My WebLink AboutPeters (3) cOf Town Hall, 53095 Main Road G �® 0 P.O. Box 1179 � �!' Southold, New York 11971 JUDITH T.TERRY `�s tp!'�' FAX(516)765-1823 lir%i�' 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. 1397-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner PETERS, JOHN AND EILEEN Mailing Address 1 58 SYCAMORE STREET Mailing Address 2 City St Zip MASSAPEQUA NY 11758-0000 Property Address 1 19A PECONIC BAY BLVD Property Address 2 City St Zip LAUREL NY 11948-0000 Owner Telephone No. 516-798-1215 Tax Map No. section 128.00 block 1 lot 16.000 Cross Street BIRCH DRIVE Date Of Last Pump Out 0/00/00 Issue Date: 3/01/90 Judith T. Terry Southold Town Clerk (TOWN SEAL) I r 4. iii OFFICE OF THE TOWN CLERK c3vFFULA- Town of Southold � C'Q Application No. 1391 Judith T. Terry, Town Clerk , � Town Hall, 53095 Main Road ~ , '` �\� $10.00 - Residential P. O. Box 1179 (1' ;k;,` $25.00 - Non-Residential Southold, New York 11971 Telephone j (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION • for OPERATION PERMIT • SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ td, DATE ),/),‘ /fa EOWNER NAME: \ e(-(AI t t 7/U JETE7 ) • OWNER MAILING ADDRESS: Se S/CA J/fl 0 -6 . 7 4Sc/q � U/1 , A1.. V 1 j - OWNER PROPERTY ADDRESS:_ /9/4 _ �=Ca��G e4/ Lvo , ) / Lif L N.\r > qyf OWNER TELEPHONE NUMBER: $7 .._ 7 f /J,,I/s' TAX MAP NO. : Section /eV Block / Lot /6 CROSS STREET: pdA/6-- TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: LOCATION MAP: Must be attached hereto before permit may be issued. (Locate building and system; give north arrow and feet of distance, approximately, • to building and closest road.) /47- 7?f: 2;( ' Signature 6f Applicant RECEIVED BY: Town Clerk's Office DATE: —_..._w-d--.._ -. _._�_��_ _..a .._�o. - - 017,...—\\N- 16 - S>� s�• 046 �` �/ G 14.: 4 ,.t r... -.05.0. la / liNe ° i '3 O \ u , . G ......... ,t- , �� C~ ;; _ • - �J i • i / ..- 0 / ..,, el�` `�°� Oyu'' BGG' y°. a A + /ft 614 ..SL � li.r �1 e( � O' . .'r k p N. / (i, NOTE 54—C 0 ��V • =MONUMENT / \ r % CP / / •�� Q °° YOUNG YOUNG / -�a� - , REVISIONS O v / / 400 OSTRANDER AVENUE, RtVERF�EAD, NEW YORK C)O �o_ _.`, (�� , ALDEN W. YOUNG HOWARD W. YOUNG G ��'/ .$J, �� U"_ Y] j PROFESSIONAL ENGINEER AND LAND 5U,RVEYOR �'1 �.` 00' ,�9 VVV LAND SURVEYOR N.Y S. LIC NO, 12845 N.Y S LIC NO. 45893 e" o�ops �5 SURVEY FOR: /` UNAUTHORIZED 4iTER4Ti0N ON AODt TION 70 -MIS SURVEr t5 A VoA,ATiON JFSECTION ALBERT A. BRISOTTI,JR. a FLORENCE C. BRISOTTI �_ ��. 7209 OF THE NE+A' •CRK STA'E ECUCATIOH ` f,, I O� LAW __ ` f��F NEW r �\ 1 s ` \\ COPIES OF THIS SURVEY MAP NOl BEARING .SPR W %< <�, °® ` THE LAND SURVE TOR'S INKS: SEAL OR 5 �C',N O�f. �'‘\•L._........_................_. ..‹ , . • (� EMBOSSED SEAL SH4L� NOT 3E 7CNSIDERED ,� �.� � �� ` C \ \�r TO BE A VALID TRUE cOAT LAUREL l GUAR T ER TO- HOME TZ DNIg10N0 �r1��AGC� TLE / GUARANTEES NOICATEL` HEREON SHALL RUN INSUR 1 CO _ I " �� \ (C`/ NLY TO THE PREPARED, FOR MH HI THE TOWN OF rt 1 r �1- V SURVEY IS agEv4pED,4ND ON HIS BEHALF SOUTHOL© ,l m I► TO THE TILE COMPANY, GOVI PNWENTAL `� ` r AGENCY AND _ENO•NG NST'TuTON L,STED BY i �• ,/ / 7 HEREON, ANO THE 'ASSIGNEES >F THE SUFFOLK CO., N. Y. / +- ' i-.�j , , LEND HG HS' T„'ON GUARANTEES ARE _ 1 �/ v.,. .-... ...�.,�..._....�.....,�... / ND7 TRANSF` A3-..-e.. ADC N. _- ---- SCALE'-,.' - 1 • TE _..SEPT \f'K= /.m....m-....�� NST T„'{)+e5 nc 5 BLE...EN' 'w,EAS. I - 40 PT 17_ 1973 -` : �:•'' ti&E '' 5 53 3 '3 40F' .