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HomeMy WebLinkAboutO'Sullivan � l OFFICE OF THE TOWN CLERK ' C�FFOUr Town of Southold _ Judith T. Terry, Town Clerk F Town Hall, 53095 Main Road _- P. 0. Box 1179 Ln Southold, New York 11971 0��I.. Telephone ? yt nir (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 20 Residential X Fee $ 10. 00 - Non-Residential Septic X. Cesspool NAME OF OWNER: Ann 0' Sullivan OWNER MAILING ADDRESS: 144 Colonial Springs Road Wheatley Heights , New York 11798 OWNER PROPERTY ADDRESS: 5692 Main Bayview Road Southold, NY 11971 OWNER TELEPHONE NUMBER: 516-643-5232 TAX MAP NO. : Section 78 Block 4 Lot 41 . 2 CROSS STREET: Corey Creek Lane TYPE OF SYSTEM: Septic Tank X New Existing X Cesspool New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: None (July 1986) • Judi . Terry Southold Town Clerk DATE: August 19 , 1986 (TOWN SEAL) T `, , r II III i _ OFFICE OF THE TOWN CLERK I,OM - Town of Southold % -:- ea Application No. Judith T. Terry, Town Clerk k t �g'� Residential / Town Hall, 53095 Main Road oma ; P. O. Box 1179 a_ x, Z Non-Residential Southold, New York 11971 O 0 ``'::,-,,e.'0 ,�`� Telephone ( �� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL - Operation Permit No. Fee $ i'0 DATE g// q� OWNER NAME: jr— iSUL-1-, /A1) OWNER MAILING ADDRESS: ) 9 -( eOkOf3( k /7_I )6S IRD WillIs7*ic-c)/ ttgl60 Si /1. l r'71Ff OWNER PROPERTY ADDRESS: 6 /rl 1q1, 13/9YV/154-) 4 ,_7() d-rkfoA ) / NI r t a 71 OWNER TELEPHONE NUMBER: 4-71O ( 43 (' 32— TAX MAP NO. : Section 7Block Lot 44 / 2-- CROSS CROSS STREET: et) RE 1 C REEK L Ald TYPE OF SYSTEM: Septic Tank 1 New Existing t./ Cesspool New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: AfOA,11:= 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.) 411414.1 Signat a of App icant RECEIVED BY: GiXc2,a_ -� Town CI k's Offi e DATE: a„_. /9, / ,i-(.,. / f;) ti T /� A� j, 1M. 6u re HARDT M. e W, 5U�'KI--HA2DY C'''.7..' °t -- °:' `' -4J O ,�9/-.- N,41°52'50''1 I �To.F�`� \ '-•..7- „,.. ,Ci 3C('\ Q �,rm1 _ r, r., N oN \ - - _ - - - �OS.o_ - I earth _ _ .' ”! = — _ _ f/ — (} kti L li CI �� I,q JIB ,,4] • --- i JJ �r 43,52 sq 7l 5.4/ 52 J _ 7 S-� �c 8.OZ f �,V!%r F 1 o he-rne✓ U �� 2� +;SIO , t- 4 X5,32 \ �� G©,F-. L Ul 1 a 5.4/°52'50"w �� / s ©AILS i44. / 11=1 jt .� l � I / ��_\ _-----6 rj i i l� (J MiJ/02 SUBDIVISION 0 MADE Fop _OC/-1T/ON Y(AP �` 5v»ith Dr, N. _ _ _ _ _ �IN _ f � ; . ; N � �% i /` 5t /NM arm514-11.-01 Or s_,______ ./Z '--Zqc2 M . 81 ,4i St f—„4.p�g /3/ /(?71 ToWN OF SOUTHOL D, NLY. Gran I G .. cr----- � I i e-,1 � � `/ 04 W j .. m -' Scale. • 501.-- r \r\' _ I Goose t , i ArE�a = Q Ac.rv :, 1 - Creek _ I � I7 r<i o t#a►+# �r^? �- i ,,/,, <TC-11/11SC-5 .- Suffolk Coun-fy Tox M'ap I)sic�nGdion! 7:,..>'--------- ------- Disf, 1000, Sec-E. 078, 81k. 4 , Pct. 4l } M _ - =Ufi1i+ t;nf.I i 7-,..ii Co��ours from Euff• Co. D.P.W, aeric I, dN S o y •`Q44 Drive Nei-Hier lo-t 4-o be fvri-hee : Z:c bdi ; u U r / \ v40, - ✓ecc SflUv+rt P`• 0HC `7-1 -