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HomeMy WebLinkAboutStoll $011 ciff[tir JUDITH T. TERRY Town Hall, 53095 Main Road TOWN CLERK rra P.O. Box 1179 REGISTRAR OF VITAL STATISTICSf� �� Southold, New York 11971 MARRIAGE OFFICER ��®`� , Fax (516) 765-1823 ®y „to 1� Telephone (516) 765-1801 r �.arrr�rrl' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3018-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner STOLL, THEODORE Mailing Address 1 11645 SOUNDVIEW AVENUE Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 11645 SOUNDVIEW AVENUE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-5536 Tax Map No. section 54.00 block 5 lot 42.001 Cross Street HICKORY ROAD Date Of Last Pump Out 0/00/00 Issue Date: 5/07/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK cjv�FJ(,� = Town of Southold ,, - CQG' , Application No. 30/er Judith T. Terry, Town Clerk 4 op Town Hall, 53095 Main Road " -'� ` $10.00 — Residential P. O. Box 1179 cr's � : $25.00 - Non-Residential Southold, New York 11971 Off. •S Telephone _ 1 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE OWNER NAME: 71/ O Jj G , C OWNER MAILING ADDRESS: 1/ hd3� 226//1/2> l// 6 (ir/ /4 I ,Sae/17—,,2a y27 IVY // y7 ( OWNER PROPERTY ADDRESS: e OWNER TELEPHONE NUMBER: LI 74‘ .1----- t/ TAX MAP NO. : Section Block Lot CROSS STREET: fuv,,J./e` � /717- TYPE OF SYSTEM: Septic Tank ff New Existing / Cesspool �� New Existing t/ Residential V Non-Residential DATE OF PREVIOUS PUMP-OUT: /d/d v L- • 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.) !,ip, ,moi Signature of Applicant RECEIVED BY: TownCerk's Office DATE: 7/s,. .r " . . t' .,', r- - h19 •,,,,1F''•t+, 1Y. • ;e•.-----,—_ -----_ ''�• fin. •<r, "!,<�tini ~- 4a, , -• 11 �' It ♦ '1, `p'J'/.�' :.•`I'.1};ks<�.;•Ar 4 tt,'"L, ' l•'•'Y1 ,t ` 'i A " •( I •.' 4,-...,"1..,-.Y D_ ,"I .,-.Y' jel;'1'! lig ' - ., 1 `<,. i „',,'.'+1,1'»- ,'r, 4. '•':, l ? L ;. • ''�•, ,Y•i,l f, : .,1 ;''.; , I .•'; ";;;' -'; ". ;".;;1'.; ' ; k`,.`..- • ,‘,,,. .. .:., .s.i:- , _ � 71 :. ..,. , 'ry ,.B ..,.,...1_,,...., 4 ; Y ll '' ,',:',/, ,:::: :: . . , FF" •,N {:' f . . .. ,.. :__ , ' ,,,:iii,1,,,..,',.. rt `I 0 ',' ltd. ,'tr • „ ' ,µ' ;_ `=�l ✓l ;e. .' I., #i r<, '. �OL-"%C7l� A ' C_F,J, D. 1Y�y:, .t' ,( +l'^7 dy.Y ,, , - ' ' -'(kl‘ P ' ,,,,: ,', ',:,,, „;,'/,'.Itt,,,'•,' ,:,-,, ,' ',,,,-, • A, 4,', ',-, : - ' • . , $,,,-;,„;',,1 • - \---- -/e-, 7/ • ' ,, '1::=1‹19'." PI; t eh".9'. ''''; ,i ,, Z.11.,• ' ,,','',.'1, ', ' '''4:',':').011 , ' ' , . 1 > F,y r.ir' '4+1f ''1 ' T '``Iy � �.• •!.[t/„, . �O , / a • ' . ,fes , , 1 � 1 •, , c' ;,• ;y. YI�}"'>:, • • 1t ., {i:'ry, : , r �'yy�l;YI • ,�" 'Wet IV 1, ?`, A .:}J. • .V.,......': 4-`^f 'L • r 0),,,.,,,,,, . r ' ie., '^• .w D ',.11 1• nV i'r 'r; i " iri'i7 .3 r. r. • • " 4e1144 " Qt, p�� .;'7,'..';':, (fir\� ` , JI • „;, ..6 ,yr'�',,�'£ , • • ,I ;Y, r' vwy'4,4 „J ug ;, 4 a }yr.a • d� 404 a; ” :. G.C.'1araf''74ec'•ti 11 ,. ' „,i, toren ki 11 Coy • '�QrQ •. :1 't1, Yi/l1 .• 'r-C14.M... ` ., , I, L . / �'ty, r /7,714,'Y 4r `Jr i, 1 • ""'' ”"Z, 7 ::.ins o .'i ; - '` 'L t`6► -1-(67 rt.? -As r 6 ° }ICJ"t/� 1 :r;,' '.,'+e.'—,,Ii ,, > i _ �, r'1 h �,{t`'N , AA