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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ®
8'7%
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
�✓ •� Fax (516) 765-1823
MARRIAGE OFFICER ® O� •
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2074-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner SKINNER, ROBERT AND ELIZABETH
Mailing Address 1 615 SOUTH DRIVE -
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 615 SOUTH DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-2125
Tax Map No. section 106.00 block ilk lot 22.000
Cross Street BAYVIEW AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 3/09/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE-OF THE TOWN CLERK
Town of Southold � `V, Application No. .(2O7
Judith T. Terry, Town Clerk ;, y
Town Hall, 53095 Main Road > _ -'� $10.00 - Residential
P. O. Box 1179 v' _ � $25.00 - Non-Residential
Southold, New York 11971 Off ��,`�
Telephone 1 AI
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE March 5, 1993
OWNER NAME: Robert and Elizabeth Skinner
OWNER MAILING ADDRESS: 615 South Drive
Mattituck, New York 11978
OWNER PROPERTY ADDRESS: S8IAe
516-298-2125
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 106 Block 11 Lot 22
CROSS STREET: Bayview Avenue
TYPE OF,,,S,YSTEM:- - 'Septic Tank- -New xx Existing
XX XX
Cesspool New Existing
Residential xx 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.)
Signature of, A'plicant
RECEIVED,.-BY: 1
- - Town Clerk's Office
DATE: (F7 MAR ° 1Szli
T n GI TR Southold
►�
H.S. Ref. # 92-SO- 94
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SURVEY OF
LOT B
"SHORE ACRES"
FILED JAN 31,1914 MAP NO 41
ATMA TTI TUCK -
AREA= 1.318 Acres of NEw
TOWN OF SOUTHOL® tie line SoPo T-MET2a�OA.
SUFFOLK COUNTY, N. Y. 4
1000 - 106 - » - 22 �,, :: ,,
Scale: 1" = 50' �in.fz:, -
9�`I
Nov. 30, 1992 Prepared in accordance with the minimum ' /o ;4glifr �- •S LIC. NO. 49618
standards for title surveys as established
PEC:�'� I �►� RS, P.C.
Dec. 29, 1992 (foundation) by the L.I.A.L.S. and approved and adopted
for such use b (5/6) • - % 0
Mar. 2,1993 ( final) Title Association.
The New York State Land P. O. BOX 909
MAIN ROAD
SOUTHOLD, N.Y. 1197/
BLD6 pp2MiT 2/10S 2 92-308