HomeMy WebLinkAboutStusvick { ,r Town Hall, 53095 Main Road
cf.. �. 4i� P.O. Box 1179
1 �°a $.• Southold, New York 11971
JUDITH T.TERRY - il°0'I TELEPHONE
TOWN CLERK (516)765-1801
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. 749-R Residential X Non-Residential
Fee $ 10. 00 Septic X Cesspool
New Existing X
Name Of Owner STUSVICK, PAUL
Mailing Address 1 STUSVICK, JOYCE
Mailing Address 2 143 TURKEY LANE
City St Zip COLD SPRING HARBOR NY 11724-0000
Property Address 1 260 MILL CREEK DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-692-7576
Tax Map No. section 135. 00 block 3 lot 46. 000
Cross Street GROVE DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 7/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
. ..S
OFFICE OF THE TOWN CLERK i�WM/rC�te'G
-
Town of Southold �� � Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Y. -� I Residential
P. O. Box 1179 "`. �x ri z Non-Residential
Southold, New York 11971 Obi
Telephoneret
°&/
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for -
OPERATION PERMIT
SEPTIC TANK'or CESSPOOL
Operation Permit No. ' 717,
Fee $ !z' ,
DATE (-3o-ffej
OWNER NAME: Pa-Gi L qt /Ieg 5-fusoGfc
OWNER MAILING ADDRESS: /(7113
tel4D SPA fit16- AMk of U/Z 2236
OWNER PROPERTY ADDRESS: , /77/( . cocE1k Di .
GO& cGD / �J� //9?/
OWNER TELEPHONE NUMBER: 576 69,,,2 7S77
TAX MAP NO. : Section /3 f Block Lot 1/4
CROSS STREET:
TYPE OF SYSTEM: Septic .Tank New Existing v
Cesspool New Existing
Residential- IV 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.)
IL' ex—
' ignat re of Applicant
RECEIVED BY:c ' ' ,
`:' -"Mkt; a,.;r erk's Office - -
DATE: PPI! 011988
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REVISIONS ' YOUNG & YOUNG
400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
ALDEN W. YOUNG HOWARD W.YOUNG
PROFESSIONAL ENGINEER AND LAND SURVEYOR
LAND SURVEYOR, N.Y.S. LIG. NO,12845 N.Y.S. LIC. NO.45899
SURVEY FOR:
EDWARD V WHITE & JANE H. WHITE
AT SOUTHOLD •
GUARANTEED TO:
USLIFE TITLE INSURANCE CO. ArN.Y.
SOUTHOLD SAVINGS BANK
TOWN OF SOUTHOLD
SUFFOLK CO., N.Y. By filhee,e// r
SCALE: /if _30'-1ATE14,q8, /972 NO. 72-140