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HomeMy WebLinkAboutSimon • �����I JUDITH T.TERRY �1® sy`, Town Hall,53095 Main Road TOWN CLERK ; > ,. ; P.O.Box 1179 I" Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ' '"i' v,im�, Fax(516)765-1823 RECORDS MANAGEMENT OFFICER " p- �� MARRIAGE OFFICER ��"dj�4 ��1 Telephone(516)765-1800 Di 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. 3356-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner SIMON, LLOYD Mailing Address 1 1945 GLENN ROAD Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 1945 GLENN ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-3199 Tax Map No. section 78.00 block 1 lot 27.000 Cross Street GRISSOM LANE Issue Date: 6/16/95 Judith T. Terry Southold Town Clerk (TOWN SEAL) • OFFICE OF THE TOWN CLERK ,c�v�F�(,t . Town of Southold �� CQApplication No. `v 3 -539Judith T. Terry, Town Clerk i+1` Town Hall, 53095 Main Road • -< $10.00 - Residential P. O. Box 1179 u' _ - ` $25.00 - Non-Residential Southold, New York 11971 Telephone _*.( * � • (516) 765-1801 TOWN OF SOUTHOLD • • SOUTHOLD WASTEWATER DISPOSAL DISTRICT --------- - -"-"- - - _ A.PPI_I CAT 10.N-- - for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ ' DATE OWNER NAME: L(.ot/r_ 5i OWNER MAILING ADDRESS:II (q `( s--- Ted 5 -0-1A/4-Lb- to OWNER PROPERTY ADDRESS: - " - A`'"^--t5 OWNER TELEPHONE NUMBER: TAX MAP NO. : Section Block Lot 32- CROSS STREET: TYPE OF SYSTEM: Septic Tank 1-/- . New Existing Cesspool -New, Existing L� Residential 2/ 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.) Sig ur f Applicant RECEIVED BY: Town Clerk's Office - DATE: - " • -- - - c.,._--_-----,__,,,„..____-.,.. ._.. -__ ________----_------- ------ • • -'1` r. � • '.�._ - :te•r, 1. - - - ^ate • _T� :} `Y - • � SFr_ ,*,/ =�L -E T` TIh - _ --t•- - - D- EYE 5IMO, OY _ _ _ - 4>t i= _ U 1' 1. i�\n/N O5-_0F 5TD! HOS J , t ,Y. = r:***: • Q _ I . - i 2�mQv - 1 1, Fe.jtG. ! - . 1 \ ' ��j - ! i - _ ! . - _ '•i'! :� `\ �- �� i• i :SCALE-Tw .� ; • , — - 4 a� .t ��� t� • I Af�EA.=x(, 57�.c, 1 • r t4 � ! '. : • ' t _p r t.!i✓'Nu P'ENT - - Z ; orf t�r ` � ' e I 111 F_ _J - _ iG\.-- - - - ia ' . t i ' r 1 -- p, '� -- - - - ...tio-ti,••a al.;rn:rar o'c[5'pxa _ ;.�t;y..:^�;�.L L:. T`.1 :}!�h f+D'✓ 1 LE 71w C.•i���r L.C �:� _ - n tY s^,•••,r a vn1••r of _ T '-- - - 1 - r...,,o:a:-r•••:heII•vTor;Srte •�J.'4�LL'`t T EEL' 7t) _JO.:i !--i0L1.) _/`.\:1;-'�.S E/-TZk. - ' /,r c•' 'a ,r yr`iM1I ^C� c.-.-p'thr-s•Pr-V Ile:A:Lmer:n; /'�• - ✓t"_ --F ' a:,--0..su r,o•s rra r e.:I o• ------- -- - pF N EbY (�r -r' :1-• 1 so.ss.:SP.%oh-:1 nm tr.Dona:dared /-'s c -r •i C_1, tr ' t•'i T• 1\.ii r)- 4.c-�G.. V5/ =D le,i�' r �: -? `}.E' f _ ?i _ _ to be.a vat.'run cc;y. =...... - - :P w, �r�� • --- -..--------- -___' _.` - ---- Gua-onto-Inflect••.'berm^sh^II run •• _ 4.O?i!4 ! n G • '..-- F. :-..1):-1.1 {c It'''':: J F F.C i_ f`•.:.- f',/.,:-a i-4r. _ 'i..:- onry to thr t--ron for whom the curvry \ �•-*-+'� -�4 "ate s�•�, �r , 'i /- --- - _ ._ ••••;"-- _ I:pranar,C.enc on h;1:bchs'f to the - . 1.• , / A-. .J - t•,f. C �-F• • ;•?)`i- ,•i--I_27, Me company,porcrrrnentol tc end L:,,,y�' _� ' ' __ ..*a lenthrrtn:tnuhon Mctedhorconard ------------- "-- — - __e-.._ - . caiySa [5 z�'_1,0..t• 1 s 1 - -- Io th.rMe';rtecs of the lorx_ry inati- 7 t.�.}ti - -• t.".".•:•1; • ",.('= • '+` 1• Fp L ANU 5� tu[+on Guarantees two not Ironrfforek4 '� 1 to*oChao.'rrrresws•a or suhea,uent ----:-