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HomeMy WebLinkAboutSyolowski "f-s07511rit'-'11, 0: 04 �i Town Hall, 53095 Main Road l� ' O j P.O. Box 1179 �!l Southold, New York 11971 Ai .JUDITH T.TERRY L-O/ �w� 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. 3570-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner SYOLOWSKI, ALEX AND EDNA Mailing Address 1 6179 SOUND AVENUE Mailing Address 2 City St Zip RIVERHEAD NY 11901-0000 Property Address 1 4.270 BRIDGE LANE Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-298-0000 Tax Map No. section 84.00 block 5 lot 7.003 Cross Street COUNTY ROUTE 48 Issue Date: 1/09/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) Fft� .0 OFFICE "•-moi OFFICE OF THE TOWN CLERK cVFFO(i Town of Southold - -- Application No. 3 7 Judith T. Terry, Town Clerk Town Hall, 53095 Main Road $10.00 - Residential k+ P. O. Box 1179 cryo�,, x ;' $25.00 - Non-Residen ial Southold, New York 11971 O� 1,. } R Telephone " 'i 1 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE 1/7 /qj7 OWNER NAME: / / / /,0, ) W; 77t22&1S'k , OWNER MAILING ADDRESS: 7,„/ 7'? Yezygp g9% 1 , UZ' G- 0 iUy/ OWNER PROPERTY ADDRESS : 7 U" g/c,//•. COTC/7/644.1J /IJ� ,/, // ? 3 5- OWNER TELEPHONE NUMBER : c.;2/`,-6(7f TAX MAP NO. : Section Block —5 Lot '7 3 CROSS STREET: W 'TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing • Residential Non-Residential 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.) Signaturfi of Applicant RECEIVED BY7� • To Clerk's Office -RECEIVED DATE: JAN 71997 Town Clerk Southold . t - _ . , 1 kouse ..... .,-11„ewist - - -- ' '-'-'-' 'f-' - •,-2,--.T. -":f.' ...„.•-1.. 1,-,7„ ,.', --..-,,, ...f.--i,--; .7,- - .. ''.,i• . - ; , ,-.7' $41' ",. 2. ,- • - — . C . . ,.. , ..4)...1 ---,- _ +. - - 4::;141. ottt, ' , , ' - '• -' ''' - '--: 4.V.'4-.1 . , : • , , '''',. opoi ,.ji eV486 -. ' • _ . Ii /ee0-a-• , ;-- , . - 0) iii . • tt„, - . . . . . . , • 1";!'..'. = - -..'' ' . N. ...... - ‘ti'l N 4 1 1 0 jk •..‹.- .6€ t . U) 6\ . . - _ G 8 e ,,-.. .5:-..„,.,....- , ,_-_-3......._ti.„, . • ,,, A "T:'.iM''',ft:::.- • I < ''....) i t 5 /t t • Az' ..,-,-",..,...‘ . -t wet( .4-,-^3.9- i: ..... 174 1 . ..y--. --,..,,...,-*, 1.-- (A ,,LsA ,L.: ,,.,y (.2°) c.,--, _= , -14 CO -4 --... - carbed 1 3.4 ..., . 6\ N • o r- r- ri--•Vt..: i4 .0 0 1 a . 0 1-- i --... 1 „'",..- .'-, • ,.., in 5 — ---r----. _____ . . ,..,, •,, -, •.-,-, - _ - S. --). I 1 C's• () 6\ —... )'t,i ,•-•,t,t—,„ , , 1 1 6\ ci Q 2 E--_---,,-1 e.-.:.-..".? z--'1Y.-14: .4 01 ' • / ' . ,,f--..,- • - IC,C 0 -t. . • , • -4:,-.4,4e) . _ .1 S. 34 - 7 50 'W I '...". 3-4 7.18 - ,,,-.. :,-,,,t•tx-v-,,*-..„ • ! ' •' ' '1'--'-':4.f.„--. ‘5,--.-4,-`t..• I 0- ! ;`\) i'VP o • PQoPae7-kie _ I ------4e3.5 • 7-* . --,5"*. .... f .. , , . ------>( * EDINI :=4 SYDi \A4/3k:ti, _ - . .,._ 1,,,,..-_-..il.... --1-- . . t . , . .,-- • ("I . CL-17-C1-40GUE , , i : - , -*-4.„,',.,',,,', ..' ' ., _— If- ,, - - - .,.--',T-;'• '.:_e Sc ale : GOt=••• 1 " , 7-ovvisiCi--- SOLIT-1-401_0, N.\‘---.. i 'It, At-eci= 1 -7---7, .5ter- 5 ' ...". ‘,-• . il ,--..-....• ....17-,--,.e. Ej = tIonuitrl-i- I : 1. 4.41t.--,"z-' -- . , _ 4) = a roil pipe -7-1-1-(a No_8.:.-77.-'(:\dS-03-7.'c,28 .„f„...,--•.;,zt.','.'r''' 1.-:-,::;;:.'rt...-e,•z..-:,..•,,,,. ! ,. . . 1-. :'•;-... ,,---it. . -, - ,_ ., „ •