HomeMy WebLinkAboutStakey sliVf
JUDITH T. TERRY Town Hall, 53095 Main Road
P.O. Box 1179
TOWN
T
REGISTRAR OTASTATISTICS a Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
, Telephone (516) 765-1801
1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1717-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner STAKEY, ROGER
Mailing Address 1 610 BAILEY AVENUE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 6210 BAILEY AVENUE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1698
Tax Map No. section 34.00 block 4 lot 6.000
Cross Street KNAPP PLACE
Date Of Last Pump Out 10/00/83
Issue Date: 7/02/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFNCE OF THE TOWN CLERK c0Fd(,'"
Town of Southold CQ Application No. /7/1
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road �;' = $10.00 - Residential
p. 0. Box 1179 cn ' s , ¢v �' $25.00 - Non-Residential
Southold, New York 11971
Telephone SO-44: 101
�;.•
(516) 765-1801
TOWN OF SOUTH,OLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE JaLy
OWNER NAME: �0 S7Ak�
OWNER MAILING ADDRESS: 61/0 ,art/LE y 111./E%
GEE ,•r Fc() Y®rek //9(14/
OWNER PROPERTY AUDRESS: 63 10 F4I L • AVE
6 EArrae , Akte,/ Yakk /19f1
OWNER TELEPHONE NUMBER: q77_ /6 2
TAX MAP NO. : Section 3 -C Block Lot 10
CROSS STREET: pp PPACE
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool Q/' New Existing
Residential Y Non-Residential
DATE OF PREVIOUS PUMP-OUT: d cr. /y'$3
LOCATION MAP: Must be attached hereto before permit maybe issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
/ Signature of Apant
RECEIVED BY:
Town Clerk's Office
DATE:
..,...___�..._� .. .._. ..._.�. ----- 1
,, ,.,,,..„,„,,,4,.....„, ,, ,,. .
,N o i- -7-1-/ ' ,z- 0--41 z_._ ' t
;�-',;.24 ,, I i
.i /7 G�'Gx / /7 /C t -c
,, rc
v.
1 ..�_ .......
\...„._
� Lsl w -
, ,- •
`s , - it /" story - ' ow t to
' \ B, --
\ o t5' ---L....... r-- - t o�
- 1 q1
1 i�G.. -
f 1 �' _ d� shed ,ti �tsS .
o 0
I , 573°2Sr00"W, -- /4U 0 :i 1�t
I 1 . Z.. •,' ../ \ \ 'N,)
�� 11,\ r',:- 5.
I \ . \ \� `"�
Al
II1I1I1 A7.qG' vim" 'A'J, 7 ` T Y
i S ) VE)'-AF.L-•' F�!_),�'
{ IRC 67--i....-.7: A/Yn L:. Z L. N STA l< }--'
} C7e�" .4Jf-,cif _ T, /\' :
t.7afie)i' Co unf'y 7:1,.c 17:1'4,1'rr� e/ /000 X34 -- 4 - 4
.41
IA n.1�0o7L/rrleei14' �j /
?�.::7;�' C� i _ / /i �edeYO2/Crel�f' do/0/7�
Amew/' 7 kJ �5-./
c_-cli 77 �e /m56/r& pie
UNAUTHORIZED ALTERATION OR ADDITION ti. •
/
TO THIS SURVEY ISA VIOLATION OF ClJif)r�G�l9c%and /() 7//C bs.Jnf_�,-. '•,:1
SECTION 7209 OF THE NEW YORK STATE !r i1
EDUCATION LAW. L�r ye-/(c' L� /y-7
-7d /6
, / 97 9
COPIES OF THIS SURVEY MAP NOT BEARING , - .. ' /J •
r Iv/ -t7�
I THE LAND SURVEYOR'S INKED SEAL OR AZ-Ode•, /�` T,S` ,ii / („/ �� .
I EMBOSSED SEAL SHALL NOT BE CONSIDERED N GT /C. CJI /
1 TO BE A VALID TRUE COPY. - j 'J/ �,�...� J'�
GUARANTEES INDICATED HEREON SHALL RUN /2, r ��T�a.-y- '1 C
I ONLY TO THE PERSON FOR WHOM THE SUAVE! 4
I IS PREPARED,AND ON HIS BEHALF TO THE ” C._ / '61 r e c:;1 z/�f,1d 3 �,e r,
I TITLE COMPANY,GOVERNMENTAL AGENCY ANO• [�,* / �t 'L��V<- /f�l I
SENSING INSTITUTION LISTED HEREON, AND - - } /.` �., �?`+T �� f/ /1 /e t,V .-."6r�[• t
t TO THE ASSIGNEES OF THE LENDING INSTI- : ( / / V
TUTION.GUARANTEES ARE NOT TRANSFERABLE {
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT .
I OWNERS. .
J1