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JUDITH T. TERRYTown Hall, 53095 Main Road
TOWN CLERK p rrZ P.O. Box 1179
trs Southold, New York 11971
REGISTRAR OF VITAL STATISTICSV® �. Fax (516) 765-1823
MARRIAGE OFFICER ` a® ��
RECORDS MANAGEMENT OFFICER _ / / 4 �v0 1. Telephone (516) 765 1801
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. 3210-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MURRIN, CHARLES AND JOYCE
Mailing Address 1 P. O. BOX 361
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 605 LATHAM LANE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-477-7860
Tax Map No. section 15.00 block 9 lot 1 .025
Cross Street LAND'S END ROAD
Issue Date: 5/20/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ���� •'-
Town of Southold QJ CQG Application No. 3 -2/0
Judith T. Terry, Town Clerk . ? y
Town Hall, 53095 Main Road $10.00 - Residential
. P. O. Box 1179 " Pg
A z $25.00 - Non-Residential
Southold, New York' 11971 O
Telephone o.( , 0 $96�`
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
IPP ...A•1 ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 5-12,57 .,-/
•
• OWNER NAME: L!, a ls, /1'1r c.y 114-
OWNER MAILING ADDRESS: P, G, 3 1
/a Ai Ai 1 6 i 4i 3 4
OWNER PROPERTY ADDRESS: CF. --4,4T/Aa'•1 L• n/'�
OWNER PROPERTY LI\1 1 !1 �
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OWNER TELEPHONE NUMBER: (511.5 s �t'
TAX MAP NO. : Section /5". Block y Lot /, LS
CROSS STREET: L 1'dns
TYPE OF SYSTEM: : Septic -Tank -- ' New Existing
Cesspool / New X 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.)
Signature of Applicant
RECEIVED
RECEIVED BY: - - •
Mffwp (F11994's Office
DATE: Town Clerk Southokt
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SUFFOLK CO. HEALTH DEPT. APPROVAL
r�0,� H. S. NO:-:23 SQ.'7g - ;
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44
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An
_;CAL'r_ - STATEMENT OF INTENT M
N,rA ' 4�`�; _�'7' I, THE WATER SUPPLY AND SEWAGE DISPOSAL
_ 1: SYSTEMS FOR THIS RESIDENCE ` WILL ••
C%',FI V e 1 CONFORM TO THE STANDARDS OF THE
SUFFOLK CO. DEPT. OF HEALTH SERVICES.-
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APPLICANT
gyp, t_ 1 j
c'ri > � i SUFFOLK COUNTY DEPT. . OF HEALTH
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SERVICES — FOR APPROVAL FOR
CONSTRUCTION ONLY
DATE
! H. S. REF. NO.. 93_SO:-79
APPROVED•
'''iAP 1F PF_r)Y E['_TT -
r tr, r,_- -"` ' Wit;.V"- -" SUFFOLK CO. TAX MAP DESIGNATION:
�(iFe-VE l rL FOri,
--- --- __ ____--__-- -- DIST. SECT. BLOCK PCL. ,
r t' /l 1 i'�.\ ,�,'_ r---- � i0. 0 0I5 9 1.25
' --_-_- - OWNERS ADDRESS:
9:0
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0,77 IBS
µ `t• •'!i OF r.C);;''L • r
__-� DEED: L. 1-1,1A P. .
TEST HOLE STAMP
t,)nauthonrsr:..•r..:.. c•e;-:.,i4ii
it)this ss,rvey;,r•; ,of
Sc•c•lon is ,::. :.J'ix..vta%
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t'.. the land sur.,ey:,,a fined esal cr'r'n($
t- embossed seal shall not ba cons:dcred
to be a valid trap cops,
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Guarartces tndlrate(t hereon sh:ttt run
;:, only to the person for whom the�irvey
i _; is prep rad,and on his behalf to toe '
AM'ENDGD FEB_ 21_(4 %MAY 3r 1994 ' i title core,;.ori,t::.arnmentalaljencyand
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LICENSED LAND SURVEYORS . - �`
GREENPORT NEW YORK