HomeMy WebLinkAboutStepnowsky JUDITH T. TERRY -, Town Hall, 53095 Main Road
TOWN CLERK �az
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Qr3 .�� Southold, New York 11971
MARRIAGE OFFICER ir �r Fax (516) 765-1823
41-e" 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. 1861-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner STEPNOWSKY, CARL
Mailing Address 1 500 TUCKERS LANE
Mailing Address 2
City St Zip - SOUTHOLD NY 11971-0000
Property Address 1 500 TUCKERS LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5374
Tax Map No. section 63.00 block 5 lot 3.000
Cross Street ROUTE 25
Date Of Last Pump Out 0/00/86
Issue Date: 3/30/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OF-10E OF THE TOWN CLERK .c0F001 #'• �r._/
' Town of Southold _� , CQG-,, Application No. D�/
Judith T. Terry, Town Clerk % '�` y a
Town Hall, 53095 Main Road �" •,.: -� $10.00 - Residential
P. O. Box 1179 *z $25.00 - Non-Residential
Southold, New York 11971 p' 1116.,-:�y� "" 0�,f`
Telephone .( '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLDWASTEWATER DISPOSAL DISTRICT
APPLICATION
ror
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
- Fee $ / 7O
DATE 7 R).-
•OWNER NAME: -
OWNER MAILING ADDRESS: cGe) —_
J /6? /lS 7/
_ _ . _OWNER_PROPERT-Y ADDRESS:- - - -- -- - - -_ - -
OWNER TELEPHONE NUMBER: -76 cS
-2 '? '
TAX MAP NO. : Section C .1 Block " 5 ' Lot 3
'CROSS STREET: _ o2.S----
TYPE'OF-SYSTEM:--=`Septic---Tank---'' ------- New Existing
Cesspool New Existing - .
Residential C/ Non-Residential -
DATE OF PREVIOUS PUMP-OUT: jtr`�7 t :L-7 6C'- '
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.)
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Signature of A plicant _
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RECEIVED. BY -. . ..
- ' " r ` — ' Town lerk's Office '
DATE: . : v -;`7 9 _ _ _ .
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.INAUTHORIr.FD�A TERATION OR ADDITION ` ' r� b n •
TO THIS, SURVEY IS A VIOLATION OF 'V .f i - PI .'R
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IDUCSECTIQN 72C9 CF THE NEW YORK STATE `V Z S 1/ I • I •I1t I
EDUCATION LAW l �
IOPIES OF THIS SURVEY MAP NOT BEARINGu. rl�, J 4. 41 '�, _
THE LAND SUE VEYOR'S INE D SEAL OR • ! _ D T 1 j� '
BOSSED SEAL S4ALL N..T EE CONSIDERED • - - 7 - t •�` I
O BE A VALID TEUE C::FY. t... 1I
_4UARANTE[S ITTDICAV'D PT7J7 7, `u;
HEREON SHALL RUN !' S
ONLY TO THE.E.S0,.VTR ‘,4rL.M THE SURVEY I I O
e PREPARED, AND O.. HIS CC.IALF TO THE �. -, 1.�, I
, IITLE COMPANY, GOVc2rE LNIAL AGLNCY ANO '•`Z •
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LENDING INSIITUTION LISTED H.RLON, AND _ is , �0 •
/jD THE ASSIGNEES CF THE LENDING INSTI- - I Z 0.
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TION. GUARANTEES Af.E OT TkANSFERABLE
TO ADDITIONAL-INSTI NS OR SUBSEQUENT _ "• N 6 o •.3?' "w, f -T-- -1/0.0
W NERS.
Guararrfeed to tsaufhold 6avi!yy3 SQ.• - �t �/ �j
arid Arn e ri c arr Tit/L'� /n d a eo rl c s to. TLI WI L�.s r6�yo -
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. 4'.5 ' sur✓, yed June 7, /976
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