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JUDITH T.TERRY ` o Town Hall, 53095 Main Road
TOWN CLERK P.O.Box 1179
REGISTRAR OF VITAL STATISTICS `' V 0 Southold,New York 11971
MARRIAGE OFFICER L 4k ��c� '.1 Fax(516)765-1823
RECORDS MANAGEMENT OFFICER --Y1j 4 ,de Telephone(516)765-1800
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. 3358-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner NEWALIS, TIMOTHY AND MARYANNE
Mailing Address 1 P. O. BOX 1159
Mailing Address 2
City St Zip MATTTIUCK NY 11952-0000
Property Address 1 320 FREEMAN ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4382
Tax Map No. section 139.00 block 3 lot 42.000
Cross Street CONKLIN ROAD
Issue Date: 6/20/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
c;94 h " ,-.i"► ,, I ire.,i.•
OFF4CE OF THE TOWN CLERK c0FOC,r
Town of Southold OHO %_---` Application No. -1
Judith T. Terry, Town Clerk �t ; . _ ,
Town Hall, 53095 Main Road -< .) $10.00 - Residential VI
P. O.- Box 1179 - - in „`' iii ' z $25.00 - Non-Residential
Southold, New York 11971 0 • __ . $
Telephone �( O
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10 •
DATE jitfl? H- , i 1
OWNER NAME:'iyYU® I"J uk.)PtLtS Co& I o itir Nuke_ke_ Q€.W ALIS
y
OWNER MAILING ADDRESS: PO (Soy, 115-6t 3aO c,vl (et
mA-v-r'Tuc jy Ilc'
OWNER PROPERTY ADDRESS : 3 QQ Fe@,-er>tan Rd_
in ATT iTuc,k IQ/ 11615a,
OWNER
1615 --
OWNER TELEPHONE NUMBER: 6R10 - aqg - 443g
TAX MAP NO. : Section /3.9.00 Block 03000 Lot ,0142 000
CROSS STREET' L l,rl ` .eq.
TYPE OF SYSTEM: Septic Tank I New Existing V
• P! E-?) ,' Cesspool ,,/ New Existing V
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.)
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,, ignature of,Applicant
I., RECEIVED BY:
Town Clerk's Office
DATE: - ,. . _ . _ -
'1"" TITLE NO._5878-5 l
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SUQDIVI.S/ON MAP F/,CED/N THE OFFICE
S•7O°:J \
OF THE CLERK OF SUFFOL,X COUNTY ON 2
✓UNE. 24, /929 AS MAP NO.577.
�' Lot
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REVISIONS
YOUNG & YO: •
�a.R� 40• t t�,
G` . f
400 OSTRANDER AVENUE, Z
RIVE•I-IE•DL N:�If412:' 0
AI.DEN W. YOUNG
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PROFESSIONAL ENGINEER AND � •
LAND SURVEYOR, N.Y.S. LIC. NO, 12645 "0'tO • W.Y�V G
•
�j(�, ` N S VBY• •
u,InUi110RIZED ALTFRA'liON OR ADOI IIUN i0 SURVEY FOR: #4• Y $Te. • •.45 o-•;5
THIS SURVEY ISA VIOLATION OP SECTION
1209,OF THE NEW YORK STATE EDUnn„ON RICHARD F. GREGORY • "� suRv�'�°°
LAW AI PATRICK H. GREGO' `
COPIES OF THIS SURVEY MAP NOT RFARING LOT 12 I' GARDEN HEIGHTS Is
.HFALAND SURVL•YOR•L' INKED SEAL .,R
•EMO�1SSED SEAL SHALL HOT DE CUNSIDFRCD
!O DE A VALID I•RUE COPY.
INAIIANTLFS INDICATED IILHEON SHALL. RUN AT
WILY TO THE PERSON FOR WHOL1 THF • MA TT I TUCK GUH4RANTEED TO;
JUHVEY IS PREPARED,AND ON HIS bEHALF TOWN OF DIME SAVINGS BANK
ISI•NCY ANOTHE LLENO 1'E 'INSTIITUTION Ii"rY. ED SOUTHOLD FAMILY ABSTRACT CORR
¢REON, AND TO THE ASSIGNEES 01 111E ••
It a g.t..EuasITU1LON. GUARANTEES AHC SUFFOLK CO., N.Y.
IADLF TO ADDITLO1141
7R SU11SE OUCN7 D1•/NE119, SCALE: 11
liniMffirjar_444.
IIVIAAINA...�..e..... I = 30' DATE: JULY Z� �9�'4 NO. '
b.Yi AG61IG. 84- 66