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JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK a V P.O. Box 1179
PPISouthold,New York 11971
REGISTRAR OF VITAL STATISTICS k " Fax(516) 765-1823
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MARRIAGE OFFICER �® .c•N•
RECORDS MANAGEMENT OFFICER : ^( ��� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER •���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3681-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner RAGAN, HORACE J.
Mailing Address 1 BOX 1331
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 555 EAST LEGION AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9517
Tax Map No. section 122.00 block 3 lot 29.000
Cross Street BAY AVENUE
Issue Date: 9/04/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 'COFf(.,j -
Town of Southold ' CQG Application No.2CR1=
Judith T. Terry, Town Clerk ? �` $10.00 - Residential
Town Hall, 53095 Main Road `
p. O. Box 1179 v' � �' $25.00 - Non-Residential
Southold, New York 11971
Telephone �?0� i
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee ,x ',. 0-rr
DATE /(7/&?
OWNER NAME: _
OWNER MAILING ADDRESS: 5,j E. J_f6/OA) I V1. ed ' 03/
17M TT/ T e, x1/ //
OWNER PROPERTY ADDRESS: .��5-- E.- �,4•G(oirJ 9'e
/ ef) y/ /( '
OWNER TELEPHONE NUMBER: c�9,g-- r
9 /7 I
TAX MAP NO. : Section Block Lot
CROSS STREET: f" y f d/
TYPE OF SYSTEM: Septic Tank y� New Existing we-
Cesspool New Existing t�
Residential Non-Residential
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.)
ignature of "ht
RECEIVED BY:
Town lerk s Dffice
DATE: J `e-I q7
J _A, TIE R BASED ON TITLE NO. /293489
LINE ALO VAN TUYL now or former/y •
. • - e OF Gy By oT958• Boutcher Estate CREEK
SURVE ApR/L 1
MADE — — ----
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NOTE: //
. 0=_p MONUMENT - - gvEI�c -i� _
THE APPROXIMATE HIGH WATER MARK SHOWN HEREON,BASED ON RECORD C -
IN OUR OFFICE OAT/NG BACK TO FEB. /926 /S THE MOST IN SHORE LINE OF `
THE BRANCH OF JAMES
I CREEK, REVISIONS YOU_ NG & YOUNG
i_ - -
- JULY 6,/976 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
JULY 8, /976 ALDEN W. YOUNG HOWARD W. YOUNG
LAND SURVEYOR '
PROFESSIONAL ENGINEER AND
LAND SURVEYOR. N.Y.S. LIC. N0, 12845 N Y S. LIC. NO. 45693
SURVEY FOR: _
JNAUTHOR12ED ALTERATION OR ADDITION TO HORACE J. RAGAN 8 MARGAR�' ,r . A GAN
THIS SORVEY IS A VIOLATION OF SECTION ale NFy,-
7209 OF THE NEW YORK STATE EDUCATION S:
LAW �PFtD W. Y X9,1`
OP'FS OF THIS SURVEY MAP NOT BEARING Q 0
AND SURVENOR'S INKED SEAL OR I�
EUB:SSE_ SEA. SHA_L NOT BE .::NSIDERED GU TES';• '•L+P '�
T^ BE .. VALID TRUE COPY AT MAI T/TUCK SO4 PLO S,,'��'��,,1' • BAN . . '
JARA, IN. CATEi, HEREON SHALL.. RUN - THS LE 'A�,ry' EE
;NLY TME PERSON FOP WHOM THE TOWN OF - CSO//�/f.�OLO 1,ySi�•- O'
SJR,EI ,5 REPARSD,PAND ON HIS BEHALF J v
'HE "_E COMPANY,GOVERNMENTAL ~
=•,C( .,N_ _ENDING INST TJT,ON L7STE0 B 7. •' i '.
-FREON ANO TO THE ASSIGNEES OF THE SUFFOLK CO N. Y. ,Y
_ENO NG 'N5T'TUT!ON GUARANTEES ARE - I DATE —'
..'2.1 TRANSFERABLE TO ADD'TICNAL SCALE• n 1
NST 7 JTIONS OR 5..8JUNE 5Ec.JENT OWNERS / 3O28,1976 5/4
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