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HomeMy WebLinkAboutPotorski • OFFICE OF THE TOWN CLERK Town of Southold Judith T. Terry, Town Clerk .• •- _ Town Hall, 53095 Main Road P. O. Box 1179 x •� Southold, New York 11971 O �, ;`;�- •• Telephone '��O • (516) 765-1801 _ TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 145 Residential X Non-Residential Fee $ 10.00 Septic Cesspool x NAME OF OWNER: Joseph J. Potorski OWNER MAILING ADDRESS: 4395 North Bayview Road Southold, New YOrk 11971 OWNER PROPERTY ADDRESS: 4395 North Bayview Road Southold, New York OWNER TELEPHONE NUMBER: 516-765-2019 TAX MAP NO. : Section 79 Block 3 Lot 16 CROSS STREET: Ships Drive TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing x Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: 1980 Judith T. Terry Southold Town Clerk DATE: November 13, 1986 (TOWN, SEAL) se OFFICE OF THE TOWN CLERK Town of SoutholdOff® � .� CQG',, Application No. /c/� Judith T. Terry, Town Clerk Z` 0411, ) Residential •� Town Hall, 53095 Main Road P. O. Box 1179 u' 54"1x Non-Residential Southold, New York 11971 O � rM' �� Telephone .( Y► (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION • for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. /y5-- Fee $ 6 DATE G74i2 /�/ OWNER NAME: Lfd Sj? /N/ TD , Sk( OWNER MAILING ADDRESS: Lf� q'5 47, b7//// L fl/ ea/0_6 v 174/(74 �j //Y./ //9 '// OWNER PROPERTY ADDRESS: ('S4e-1 - ,944o !/C) OWNER TELEPHONE NUMBER: ( 7 6) / 9 TAX MAP NO. : Section_ Block 3 Lot /‘ CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing X Residential)( Non-Residential DATE OF PREVIOUS PUMP-OUT: / 9 g O 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.) o •'I Signure of Applicant RECEIVED BY: \�K ctti- Town Cler is Office PAWED DATE: NOV 13 ticcaio Town clot seam @ 4 v, t. Meadow Por•7f P,ropet-fees , Inc. , NI I IY4 �r S. 68'37'30"E. 170.06 - ~~ V t, , CO rA0 - - - - v Z , . . - %-T — -fes ' r ,p a i4 �� .../....,'''''' to cdriyewc,y ; K -.. z t.,) l N O' • N v :. 0 v 4 UN zr Q i s CZ `:) �, ° 0 �. 4 m NI9 . N N - Z N tSAl. 68'37'30"W. /4,0.0 , U A 1 Meadow Poinf Properties , Inc. ? ' scale : 40'= (" . MAP OF LAN© © =tert o rt cl rn e yr f S Uzv4Y6-0 POS ` JOSEPH J. `ELEA Z L. P47•O 51 -1 �. :. . . r: . AT GOar-arlteed f-o Me Nome 77t-Ie Ditilsi,orl-Ckicayo, . - f, ,s ?i,LI 'INsurance Co. and the Valley Ngfioaa - T01�t//(V OFS4fJTiYDLdy Eank, a� suvveyed Decctrrflaer 1.4rr14,f•', ,s N.1! VH.N TUN') arta SON ':•-:,-,r;);;;;;:ay: s' -• '`LiGertsecl ' 1.at�c:l Suv cyors,p. ,`• i.i,,,}';'` ,`_' . .hr • 5.uv 'fie. i.l,•� • . ? . ' • ' Gveeprporiy New York ' • r• ti'- r• s ;!: ` ,