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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK T P.O. Box 1179
REGISTRAR OF VITAL STATISTICSs CP • �� Southold, New York 11971
MARRIAGE OFFICER y® ®� ��, Fax (516) 765-1823
ilk .0. Telephone 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. 2041-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner STEINER, JACK AND LAURIE
Mailing Address 1 850 TOPSAIL LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 850 TOPSAIL LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1554
Tax Map No. section 79.00 block 7 lot 17.000
Cross Street NORTH BAYVIEW ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 2/22/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
7 1
III ,
,"O.FFIC`E OF THE TOWN CLERK c�uFFOUr
Town of SoutholdCQ • Application No. r,?®VJ -
`
Judith T. Terry, Town Clerk ' �, ► 't
Town Hall, 53095 Main Road g k , $10.00 - Residential L
P. O. Box 1179 $25.00 - Non-Residential
Southold, New York 11971 0 -� , ,',',,, *-$
Telephone Sm .1% to
(516) 765-1801,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
- APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE / / 131q....
OWNER NAME: ' 41 Yie -e1nE"r
OWNER MAILING ADDRESS: .? ,o 3I a ,
u4-h o 111 c4 ( 1 Q'-././
- - -OWNER PROPERTY ADDRESS. - (1,8 CLIETC�F -
OWNER TELEPHONE NUMBER: 7 06-- J Lc (('
TAX MAP NO. : Section 1 9 Block s Lot i
ti
CROSS STREET: ("� hQJU\ LO d
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 building and closest road.)
Signature of Applicant
RECEIVED,BY:.."
Town CI rk s Office,
DATE: JAN 21 193 '
Southold Town Clerk
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Lot 39 / Lot 41
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• SURVEY FOR
JACK STEINER 91 LAURIE STEINER OCT. 27
LOT NO.40" LEEWARD ACRES AT BAYVIEW" JULY 14
AT BAYVIEW JAN.22
DATE: APR 19,
TOWN OF SOUTHOLD SCALE: 1":50'
SUFFOLK COUNTY, NEW YORK NO. 85-23E
N UN4UTHOR12CO ALTERATION OR ADDITION TO THIS
SURVEY Is A VIOLATION OF SECTION 7209 OF THE GUARANTEED TO
NEW YORK STATE EDUCATION LAW SOUTHOLD SAVINGS BANK
*COPIES OF THIS SURVEY NOT SEARING THE LAND
SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL PEERLES.�-ABSTRACT CORF
NOT BE CONSIDERED TO BE A VALID TRUE COPY JAC e,ilIALOVG10`1 ER
:PARTMENT-DATA FOR APPROVAL TO CONSTRUCT *GUARANTEES INDICATED HEREON SHALL RUN ONLY 10
THE PERSON FOR WHOM THE SURVEY IS PREPARED 1
AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- I , �' 0.;,
:ATER MAINMI.. *SOURCE OF WATER' PRIMITE✓PUBLICS MENTAL AGENCY AND LENDING INSTITUTIOLISTED �� A- 1;t.9`
'AX MAP DIST 10110 SECTION P711 BLACK�L LOT 017 HEREON,AND TO THE ASSIGNEES OF'THE LENDING
NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE '` 2�
THOSE SHOWN HEREON. TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT !`
SUPPLY AND SEWAGE°DISPOSAL SYSTEM FOR THIS RESIDENCE OWNERS ;y _ D
:M TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT N DISTANCES SHOWN HEREON FROM PROPERTY UNES , / °'• ',�i
SERVICES• TO EXISTING STRUCTURES ARE FOR A SPECIFIC • `'"
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OT
PROPERTYPURPOSE AND LINESRORNFORTO THEEUSED TO ESTABLISH ERECTION OF FENCES `F't.� " •
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�•� �`- YOUNG & YOUNG R��T D"NE
= MONUMENT ' ''
1
F, ALDEN W.YOUNG,PROFESSIONAL ENGINEER
MAP FLED IN THE OFFICE OF THE CLERK OFSUFFOLK AND LAND SURVEYOR N.Y.S.LICENSE *0.12845
1 JUNE 4,1971 AS FILE NO. 5599
4 OF WaL(w),SEPTIC TANK(ST)•CESSPOOLS(CP)SHOWN HEREON HOWARD W YOUNG, LAND SURVEYOR
=0 OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS N.Y.S.LICENSE N0.45891
SONS INC. 1046 -