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JUDITH T. TERRY ►+ Town Hall, 53095 Main Road
IZ P.O. Box 1179
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
"?`-'41b.4.,, Southold, New York 11971
MARRIAGE OFFICER
Fax (516) 765-1823
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a1 .•► Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2025-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner SLATKIN, DANIEL AND MARA
Mailing. Address 1 18 SEACLIFF ROAD
Mailing Address 2
City St Zip SOUND BEACH NY-A:38000.-0000
Property Address 1 LONG CREEK DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-821-0469
Tax Map No. section 52.00 block 3 lot 3.000
Cross Street LAUREL ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 12/23/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE -OF THE TOWN CLERK
OC��FFN�'C
j down of Southold
Judith't. Terry, Town 'Clerk'
Off, :; ;::. Application No.� ,
Town Hall, 53095 Main Road.' y < $10.00 - Residential
P. O. Box 1179 cai••3 ':`fit* 2,. ;: •
� � � �,.,.•,� • $25.00 - Non-Residential
Southold, New York 11971 O ® �- $
Telephone _Q( stt
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
• OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. .20067
Fee $ •
DATE - /f OZ
'OWNER NAME: 04,v/ �l /1,4,4 -S'7T JV •
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OWNER MAILING ADDRESS: aJ6
OWNER PROPERTY ADDRESS: Ld -r -41? 1p/2‘
7c.t ' y // 7/
OWNER TELEPHONE NUMBER: e2 / -u Y67
TAX MAP NO. : Section J Block Lot
CROSS STREET: L i e-eL
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential 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 build' • and clo_ .- t road.)
Signature of pplicant
RECEIVED BY: .
o n Clerk's Office
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DATE: JZ / 7 4 „.„--
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EASEMENT AS DESCRIBED IN DEED • CO„. ',
TO EDWARD J KADLIC 8 THEA KADLIC p;
LI BER 11207 PAGE 562'AN0 IN DEED TO m \
DANIEL N SLATKIN a MARA B SLATKIN j
LIBER 11269 PAGE I ...77:.i.:_—_
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SURVEY FOR
DANIEL SLATKIN NOV 27,1992
MAY 28,1992
LOT 3RLONG POND ESTATES, SECT ONE" APRIL 27,1992
AT SOUTHOLD DATE FEB 13MAR 13,1992 •
TOWN OF SOUTHOLD SCALE I"=50'
SUFFOLK COUNTY, NEW YORK NO 92.0107
■UNAUTHORIZED ALTERATION OR ADDITION TO THIS CERTIFIED TO
SURVEY O A VIOLATION OF SECTION 7209 OF THE DAN IE _„,_,,,,..' I
s
NEW TORE STATE EDUCATION LAW U ' i.• K,ITS SUCCESSORS
R COPIES OF THIS SURVEY NOT DEARING THE LAND /�, I C
SURVEYOR S INKED SEAL OR EMBOSSED SEAL SHALL ` �✓
NOT NE CONSIDERED TO BE A VALID TRUE COPY -` 0�
*GUARANTEES INDICATED HEREON SMALL RUN COLT TO Q W Y
THE PERSON FOR WHOM THE SURVEY IS PREPARED
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT ‘1 Gy T*
AND OI HIS BEHALF TO THE TITLE COMPANY,GOVERN-
S NEAREST WATER MAIN IN 2 *SOURCE OF WATER PRIVATE PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED y O y�-.1 i G�
M SUFI CO TAX MAP DIST 1000 SECTION_12.12 BLOCK�L L072121_ HEREON.AND TO THE ASSIGNEES OF THE LENDING T = I,.:/yYly`I
*THERE ARE MO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE MOT TRANSFERABLE r_� .1
r OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
M THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE OWNERS l*
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT *DISTANCES SHOWN HEREON FROM PROPERTY LINES UT
TO EXISTING STRUCTURES ARE FOR A SPECIFIC 48 4589
Of HEALTH SERVICES PURPOSE AND ARE NOT TO BE USED TO ESTABLISH �/
APPLICANT, PROPERTY LINES OR FOR THE ERECTION OF FENCES FDLANDP
ADDRESS
NOTE TEL YOUNG a YOUNG PERI EERHEAD,NEW YORK AVENUEOSTRANDER
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF ALDEN W YOUNG,PROFESSIONAL ENGINEER
SUFFOLK COUNTY ON DEC.27, 1985 AS FILE Na 8037 AND LAND SURVEYOR N YS UCENSE NO 12845
- HOWARD W YOUNG, LAND SURVEYOR
N THE LOCATOR OF WELLIWI,SEPTIC TANRISTIG CESS OOLSIOI SNMAN HEREON N Y S LICENSE NO 45893
ARE FROM FIELD OBSERVATIONS AID OR DATA OBTMNEO FROM
BRAND'S a SONS INC 1046