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HomeMy WebLinkAboutNorton o J► JUDITH T. TERRY = Z Town Hall, 53095 Main Road TOWN CLERK O ►-y� P.O. BOX 1179 cl°i REGISTRAR OF VITAL STATISTICS Southold, New York 11971 y • � MARRIAGE OFFICER Fax (516) 765-1823 ® ®� Telephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3101-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New X Existing Name Of Owner NORTON, SUSAN ------------------------------ Mailing Address 1 P. O. BOX 762 ------------------------------ Mailing Address 2 ------------------------------ City St Zip UPTON NY 11973-0000 -------------------- -- ---------- Property Address 1 935 STROHSON ROAD ------------------------------ Property Address 2 ------------------------------ City St Zip CUTCHOGUE NY 11935-0000 -------------------- -- ---------- Owner Telephone No. 516-734-2593 ------------ Tax Map No. section 103.00 block 10 lot 7.000 ------ --- ------ Cross Street BALDWIN PLACE ------------------------------ Date Of Last Pump Out 0/00/00 ---------------------------------- Issue Date: 8/18/93 Judith T. Terry -------- Southold Town Clerk (TOWN SEAL) OFFICE -JF THE TOWN CLERK SNFF / - Town of Southold �� CQG Application No.&/-D-/— - Judith T. Terry, Town Clerk - a Town Hall, 53095 Main Road -� $10.00 - Residential P. O. Box 1179 v' $25.00 - Non-Residential Southold, New York 11971 O Telephone( (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE (©/30 593 OWNER NAME: Soz cLra tim4z.n OWNER MAILING ADDRESS: oK 0. OWNER PROPERTY ADDRESS:_ OWNER TELEPHONE NUMBER: 7 34 •-c:R l4 9&j---ky 94 ((A--, TAX MAP NO. : Section O ®O Block 1 ® Lot �L ®d® CROSS STREET: le)04 °P�ck- CQ TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential 16 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.) Signature of Applicant RECEIVED BY: Town Clerk's Office DATE: SUFFOLK CO. HEALTH DEPT. APPROVAL i H. S.' NO. �: _ -Ida STATEMENT OF INTENT e C;-.4/�G7t�sN;`r S1O THE WATER SUPPLY AND SEWAGE DISPOSAL 'U SYSTEMS FOR THIS RESIDENCE WILL ( Q CONFORM TO THE STANDARDS OF THE t6.6 '. 175HOLE-�TO.TESHOLE- �, -� vM;$�-���;.'� Z„ „- - - .... �4Q•y, i�' _ _ Q I � SUFFOLK CO. DEPT. OF HEALTH SERVICES. WELU- CONC.COVER, APPLICANT •4 i t 11 � .=- \\ � ; �,,r IFI t SUFFOLK COUNTY DEPT. OF HEALTH _ f _ W til } SERVICES — FOR APPROVAL OF EPTIC cNSC-M) 4, CONSTRUCTION ONLY DATE: 4A el `} � S� U , H. S. REF. NO.. +- 89 a �• 1 o 1 APPROVED: LJ ' '�} o 0 `,. � t• 'SUFFOLK CO TAX MAP DESIGNATION: 25 �� . • 0. DIST. SECT. BLOCK PCL: �� '> € 1 'I � W 1000 103 i o 7 L ---- _ ? �7•t OWNERS ADDRESS: P.0,13. 762 � + '.0 E�ft)�•i•i�l�Y. 'X --- HQQVATH / _ _WELL-_ W 40 j -SCALE L0 jSf 'L DEED: L.-1977' P. 32n�2EF) PIPE TEST HOLE STAMP `• ^— ��tS�- ', Unauthorised alteration or addition \0C. I.COVE(?- to this survey is a violation of Section 7208 of the New York State Education Law. _ '(r To P SO I ti Copies of this survey map not bearing ��. I .�. -i � ,��, , the land surveyor's inked seal or �_ ''`t .a a-,, �� embossed seal shall not be considered �...p , ^r, ? r O to be a valid true copy. Guarantees indicated hereon shall run C,i i 4"e� yam( 1 {tT+r;r �' p only to the person for whom the survey -tea.•i.f R V E .! ~ 1 'vs G 1 -� . I O A. .M .{o V to a corn ed,aro ve his behalf to the title coir+pary,gc•�ernrrtental agency and �f7 lending insututicn,;sted hereon and .” r���' .. �� _ t _ ��✓ j nsU- ;N1- to the assignee,-rt the lending fern 1 1 tution.Guarantsus ars not transferable -- to additional institutions or subsequent ownersa MAP.AMENDED ._I`Iov, 16..i�9?, MAY 5 IQ 3 -SAND i JULY 19 1,993 - i SEAL r �• r `.BOG NE �O RODER ICK VAN TUYL, P.C. No.us N14' zsszs ,��o — LICENSED LAD SURV Y_ORS 1 �P GREENPORT NEW YORK A SFOtANDS