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HomeMy WebLinkAboutPillai •�t� ., /�c, ® ✓,� COf[kir 14. gfa b . Town Hall, 53095 Main Road ��`� P.O. Box 1179 (��/��/� s2 ®� ' Southold, New York 11971 JUDITH T.TERRY i® '��I 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. 1385-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner PILLAI, DR. BALA HARI Mailing Address 1 8280 PECONIC BAY BLVD Mailing Address 2 City St Zip LAUREL NY 11948-0000 Property Address 1 8280 PECONIC BAY BLVD Property Address 2 City St Zip LAUREL NY 11948-0000 Owner Telephone No. 516-298-5978 Tax Map No. section 126.00 block 11 lot 19.000 Cross Street BRAY AVENUE Date Of Last Pump Out 0/00/00 Issue Date: 2/15/90 Judith T. Terry Southold Town Clerk (TOWN SEAL) eP • • OFFICE OF THE TOWN CLERK ' .COFD(,r '- Town of Southold Application No. /3?S •, Judith T. Terry, Town -Clerk R f r �` $10.00 - Residential r/ Town Hall, 53095 Main Road {.- p, O. Box 1179 un by hzi � .t �,�,� �, � $25.00 - Non-Residential Southold, New York 11971 O °® 1. Telephone (516) 765-1801 • TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION -tor OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • • DATE ) 71) /9Y6 'OWNER NAME: Z4 t4-- I-1 ?(tA ( • OWNER MAILING ADDRESS: R-02RQ AFc0/1 I( ,64' ( UPJ 4 LP/ec/_ / N - //fry OWNER PROPERTY ADDRESS : AS /NO Vie- OWNER TELEPHONE NUMBER: oW (.C-97(fr- TAX MAP NO. : Section fa Block If Lot /99 CROSS STREET: %)lQ Y ,4 OF TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing / Residential I 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.) )04, urelicant RECEIVED BY: Town Clerk's Office DATE: 4a . / Y e' o 9• 3h i.: • y off' C.53 eP h ,. 73 pO b e • \G ••5�6 moo_ Rh;O. `" o r& Q 0 -13 C. t 3 i"?:, .•, 9 Vutog." 0 11.d •'ib0 / c. 111 ll 0 N 1• V•• coQ kJ� 60 Oo • O• = fJ m 4/,':f,;;=o F� �j 9 NO. s' �r rr 0 0 N - o��© • SF' - • • _o_'*.. N.$' :3'• 't,. Z bC4 (cr - es\ (:). AREA `' 0 t C. o O C FLCM 411.V...p icoSA--CT. " ! w w -n !o O �. s 1} CO Y K • 2\ C:2. T1,y / Si• - 1 / N !LA � CO / 11 \I/c1; ,i \G r1 ' J /,/• .— •SURVEY'FOR 1_ ; ; BALA HARI PILLAI ;.• AT �AATTITUCK MAY 4, 1981 DATE : APR.27,1981 TOWN OF SOUTHOLD SCALE: 1"=40' SUFFOLK COUNTY, NEW YORK NO. : 81-199 • A UNAUTHORISED ALTERATION OR ADDITION TO THIS GUARANTEED TO. SURVEY IS A VIOLATION OE SECTION 7209 OE THE NEW YORK STATE EDUCATION LAW SUFFOLK COUNTY NATIONAL BANK ' K COPIES OF THIS SURVEY NOT REARING THE LAND CHICAGO TITLE INSURANCE CO. SURVEYOR'S INKED SEAL OH(MROSS(O SEAT SHALL NOT RI CON51D(R(D 10 R(A*A1 II) I11111 COPY RGUARAN TICS INIIICAIL I.N(111 T•II SIIAI I NUN IINIY TO THE PI RSON /OR rHON THE sooty/. `r V.%PN(PARI 0, 0 APO 4N NIS RLIIAI I 10 INC I III I COMI'AN.,411VI RN ti( :.`i, f,l,r ' MENTAL A4TNCT ANDD 1NIII•.4 N IhSII IUI ,N II)IED II ." 1 ` HL NEON.ANT) III I NI •)'.14,1114 Of INT IINDING .11� L ItI NEC • ' f . 10 A001 TIONAL INSTITUTIONS ON SURSIOU(NI T +�\r OWNERS �/ 1 TE ■:MONUMENT A DISTANCE SHOWN RENTON/NOM PROPERTY LINES E 101.1511100 SIRUCTUNI S ARE EOR•SPI Cl/IG SUFF CO TAX MAP-DIST 1000 SECT.126 BLK II LOT 19 PURPOSE AND •R1 NOT 1O RE DUD 10(S!ANL IST1 I 1 + L 0: STAKE PROPERTY LINES OK EOR THE ERECTION 01 FENCES \` \ /- _ N •