HomeMy WebLinkAboutSlotkin (2) 71
Town Hall, 53095 Main Road
P.O. Box 1179
!� Southold, New York 11971
JUDITH T.TERRY = r:/'��� FAX(516)765-1823
��� TELEPHONE(516)765-1801
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1180-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SLOTKIN, JAY P.
Mailing Address 1 DAVIS-SLOTKIN, M. JOANNE
Mailing Address 2 P. O. BOX 246
City St Zip NEW SUFFOLK NY 11956-0000
Property Address 1 230 KOUROS ROAD
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-765-1414
Tax Map No. section 117.00 block 6 lot 16.000
Cross Street GRATHWOHL ROAD
Date Of Last Pump Out 0/00/84
Issue Date: 6/30/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
av
•
OFFICE OF THE TOWN CLERK,,, t ���FO� •: �/ a
Town of Southold �Q, ,. jl'OG,-;, Application No + -
Judith T. Terry, Town Clerk `��.?.::::V v: 1 �'� $10.00 - Residential
Town Hall, 53095 Main Road 8445
P. 0. Box 1179 cn - '•4 u€ i �`' $25.00 - Non-Residential
Southold, New York 11971 O� ®R'`'' b. � �
Telephone Q( `W�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
° for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 1O,0o
DATE d(al \Cllg9
OWNER NAME: 70.1 p sL01 K.-I it1 'I- I'1•TQiVl'LB"- i0.4/l..S-' Stele-fn
~� i
OWNER .MAILING ADDRESS: 1'•): iSoX 24(
N at:FFo1_4L1 pl IIg5.
OWNER PROPERTY ADDRESS: 2 3o mut.eDs 0
.4) _
pew r Po LIL_ , NV I (q_/
OWNER TELEPHONE NUMBER: (5:10 745_t ito-i.- (kin) - , Q
MOO .- i®7_ 6 -/b "
:<r_
TAX MAP NO. : Section Block Lot
CROSS STREET: KI,I.u?.o5 RD(La 1- GrA,`('VI,a1B-kto P..ot
TYPE OF SYSTEM: Septic Tank New Existing ' V
Cesspool " New Existing ;
- Residential ✓ Non-Residential .J.1,
DATE OF PREVIOUS PUMP-OUT:
198.4 ;,.
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.)
ii\/ \)161\/IS - Weiv----' -
Signature of Applicant
RECEIVED BY: '
Ti c Ek's Office
DATE: JUN 3 0 1 fi`�
�� .
- - r
J SUFF.CO. HEALTH DEPT.APPROVAL l H.S. N•0.7-60•17.
t JEPV.."Su/�O�:K-Ava. ii/P:' � � • ✓�� _
NEW:6t.1s Cr. N.`,';-..4 f95 . ; - • ,
,{' _ = '(,Tel,734.69!0 _ . :
' - I
,R EA:- f,,r--;'9 ,2`;: '.¢'1:`
••,'„,:,,,,,,,,,
'EEO:1..:,G278),'f..` 59 (Ref) . 1
, . , ' ''•,-. ' ': ',N. '',''':',":'.,1-' '
. 5,-81,`...'Zi: 30"E-2,- – - ---2'.j1----'------,'-'.— ' 7:7'7; '''''4,1
_ - (5'9,0Q .. _ 150.03 .*f
�y w l , , . .
•
.• { NIlit
h -� l r I iso. LL 4
i f 't
Hyl • 1• .+', ' -< i �" (\1 4,.� I�„ t s,
r r,,1 ' . 2' 109.0 �, /r \ .^9
s .N.-78'541A/ SCALE: • 'DO y
, . `- 4.84 • "rst,;
y
O(./Q C�= IYCt7f
., ` _ ( v
� ac.)
- _. _.. .
•
` IJV".:,;:,,"4._,,-,'!'„,, - ,. - ' W4ITHnatim All DT(( 7DD.r ilI�
- ,•PO THIS SURVEY IS A VIOLATION OF •�'
ECTION 7209 OF THE NEW YORK STATE
_ 11_� ) r` EDUCATION LAW.
f- COPIES OF THIS SURVEY MAP NOT REARING '^,' l
4 Tib,.( (•`10,i, • THE LAND SURVEYOR'S INKED SEAL OR ' I „'F
= " EMBOSSED SEAL SHALL NOT RE CONSIDERED
:° :; _ • ` - • RO RE A VALID TRUE COPY. - If
C UARANTEES INDICATED HEREON SHALE RUN
ONLY TO THE PELSON FOR WHOM THE SURVEY
';‘ I
' I I PREPARED, AND ON HIS BEHALF TO THE
t r ) 1 'TITLE COMPANY,GOVERNMENTAL AGENCY ANO I
N F".W '; ' ' 5u F''-rcpt,,,,f A\/F7 kNDING INSTITUTION LISTED HEREON,AND,' .`:1 I
t
TO THE ASSIGNEES OF THE LENDING INSEE` 1
ITLE" r CERTIF. 177;--1/4,•• :v:" r?7 lL k-^L�Tj ADDITIONAL INSTITUTIONS OR SUMIE0AJTION.GUARANTEES ABE NOT 6NT I i
1 STAMP i
�^ 1• I,. b "l.Jr'i /r
! Y1 r- c. '�t=2:r_f SEAL 1
J-4T rs:, af/7' L't. /a'r CI•_1. 7, I'/ 74-3
\ _ , --_ RODERICK VAN TUYL. P. C. ,I