HomeMy WebLinkAboutMoisa (3) -,,.
JUDITH T. TERRY ` Town Hall, 53095 Main Road
TOWN CLERK ® v� P.O. Box 1179
c s Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = V>® Fax (516) 765-1823
MARRIAGE OFFICER ® 1�
RECORDS MANAGEMENT OFFICER _ ® ��� Telephone (516) 765 1801
411
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3212-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MOISA, JOSEPH JR. & CATHERINE
Mailing Address 1 P. O. BOX 1239
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 235 DEER PATH
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5906
Tax Map No. section 106.00 block 10 lot 28.003
Cross Street MILLERS ROAD
Issue Date: 5/26/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
'OFFICE OF THE TOWN CLERK 'i �FFO��'��=
• �, QG Application No. 30h7�
Town of Southold ,•�
Judith T. Terry, Town Clerk ��"
-
Town Hall, 53095 Main Road -'� ' $10.00 - Residential
P. O. Box 1179 ') � $25.00 - Non-Residential
Southold, New York 11971 O ®, ���
Telephone 01 �►�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT '
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 43 4V
OWNER NAME: sFPl 7R d- PO" -Fi)AJ ' MoS4-
OWNER
MAILING ADDRESS: Pci- C ( j 9
1 nicicitzsy
OWNER PROPERTY ADDRESS: 0367— 7o3714
`IAC
OWNER TELEPHONE NUMBER: ,29e-5341069
TAX MAP NO. : Section J6(c) Block /0 Lot (3
CROSS STREET: ,iL_L 5 ROA-1'N
TYPE OF SYSTEM: Septic Tank 7` New Existing K
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..)
(21/1-ei G /1
•
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
. .
. . ....,
ki-...,
f�O�
/46626'N‹.- . . •
- -
I
--
NI 1 _r_.
"41/LLERS " t' _
------.\ _
u, Right
I .
___ • c4_,::::„..\\___,:________________
___________.,__
O
% In
..
\ __________ \I
• .___________
_____ __ _
• m \ •�
O
•
_.
y �
\` formeP1Y z. -•� 11��� �� 5j(0°5213.3 =6�"A�•
` � ,s+mc;:c. 3c.
\ gL• �.
ca
\\917".'z'L9f4 .,
61030 0a"�, /' +....: it
ii
N � ,'iT sfi�� ��
I _51;T...1-
0,'"c.
t a•
r
,' 54 I Ii •
e::: \
T - s. '- \ 0V'° E�'
•
a ;•
-• o_ 8°$98 cP Test h°�e 9Orion Set `'\
0 0 : 2 24
4 ,:-4_ , _ Ade . - -\.\4":
- - jIII�_9.._I_� tSJST' -_ r — D _ _ RI' .... ! - -
1 r -3 O lo°• , •.
C.' +6`.A0Y 1030
6
*.,...0' mon.
set
- \I .
1 \` 00°
- \\ .
sand
a
grove/
•0
llin9 I
pee /70'
•
•
SURVEY FOR
JOSEPH 8. MO/SA, JR. a GATHER/NE MO/SA -
•
i
AT MATT/TUCK DATE NOV. 6, /979
\`� TOWN OF SOUTHOLD SCALE• /°°=S0°
SUFFOLK COUNTY, NEW YORK NO • 79-6/6
•$UNAUT4(IRIZED Al TERATION (IR ADDITION TO THIS GUARANTEED TO:
SUPvEY IS A VIOLATION IT SECTION 7709 OF THE THE T/TLE GUARANTEE CO.
NEW YORK STATE EDUCATION LAW
* COPIES OF THIS SUNvFv NOT REARING THE LAND SOUTHOLD SAVINGS BANK
SUNOTEYOR S BE CONSIDERED D StU RE A VAL+IIt) TRUE COPY SEAL SHALL JOSEPH B.,JR. a CATHEN /NE RIO/SA
`.— _, 0GUARANTEE S INDI A TED HERE UN SHALL PUN ONLY TO AS SURVEYED ON JAN. 8,1979
HEALTH OFF'ARTMEN T-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOP %%Hum Till SUP VE IS PREPARED, •
AND ON HIS BEIM I TO THE TITLE COMPANY,GOvERN-
* TLCARE^•1 WATER MAIN_MI t M-SOURSEOFWATER• PRIVATE PUBLIC _ MENIAI A6FNC, ANU LENTIING INSTITUTION LISTED . -
w SATE CO TAX MAP DIST SECTION RLOCFL 2LOT — HFRFON,APP r'. <,+I A-:Ir.NFE• IIF rHE LENDING • . .cc OF NE
H THERE ARE NO OWELLINGT WITHIN 100 FEET OF THIS PROPERTY tNSTITIII ION •TIIARANII I . API NUT TRANSFERABLE qP V
I.TIIER THAN THOSE SHOWN HEREON. TO API ' 'OPAL IN •IJ'UI (7N= UR StiBSFOUENT 5 D �. y 0,�
I/ THE WATER ,IIPI•LYAND'TFWAGEDISPOSAL SYSTEM FOR THIS RESIDENCE OWNER ' • ,j*QEt
HILI CONFORM TO THE STANDARDS OFTHE SUFFOLK COUNTY DEPARTMENT {0 f'I:TnNrt ; SH(IWN �EHFON FROM I•ROF•ERTY t INES O OG •
(`t HEALTH 9FRVICES re EvsTING SrRUCTURT S ARE FORA SPECIFIC '
I`URPOSL AND ARE NOT Eu BF USE(1 TO ESTABLISH4. •
ADF'LICANT - P17DhF Ply LINES OR I OR THE FRFr TION OF �� P - p'
ACIDREGS _---- /At 3., 1 —'-1
-- - r
TEL., 400\4 DER VE UF
- - — - - _�- _ N YOUNGYOU C • RIVE '• fli§ 9Y0 'K
lag'. f''Y ALDEN W YOUNG,rRnrESSIONAL ENGINEER . .
;
• ",.. •ft,,.z AND LAND SURVE/OR NY5 LICENSE NO.12845-, ' }' < '--
-- — HOwilRDW YOUNG,LANDSURVEYOR gZd � • I'
0