HomeMy WebLinkAboutTerry (4) ®cf f DLitt.;-..
i=1 Fri
tri Town Hall, 53095 Main Road
®� P.O. Box 1179
®1 A �,,•� • Southold, New York 11971
JUDITHsr T.TERRY � ����''`
FAX(516)765-1823
TOWN
CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1532-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner TERRY, RAYMOND W. JR.
Mailing Address 1 P. O. BOX 983
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 610 JOCKEY CREEK DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2567
Tax Map No. section 70.00 block 5 lot 11 .000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/26/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I • •ice 0'' •
OFF�C� CSF THE TOWN CLERK ��FFour
Town of Southold � C'Q �,, Application No./S-3
Judith -T• Terry, Town Clerk -tet �fi xx y
Town Hall, 53095 Main Road :'� $10.00 - Residential
p. O. Box 1179 cry �4t � : z $25.00 - Non-Residential
Southold, New York 11971 O 0-1°9°Telephone *Q( •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL •
Operation Permit No.
Fee $ •
DATE 7/2 /7
'OWNER NAME: f/gyilavc, e/
OWNER MAILING ADDRESS: 5,
OWNER PROPERTY ADDRESS:
.50/-17/0/1 (Ai , ./,/2 /
OWNER TELEPHONE NUMBER: S//' 7,6
TAX MAP NO. : Section 70 Block 3 Lot /7
CROSS STREET: 4;Aiper
TYPE
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing (®�
Residential i/ 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.)
•nature op !leant • ;
P261°
RECEIVED B
l
we' Clerk's Office
Iown-DATE:
Y. ,,c:•. a -m _ - __�.. _E. --__.... ...E�.1 .- - �_'
---�..__ -'s-
•
- 4
DRIVE - ! i L��►� J 7 1--,i' ' . _1 ' 1 - I
JOCKEY C',�cEIC Y .
::y ��. i— i.., / s'e j r.,,
5.7716 'E. r -11
a' i
110. -f A/i�� /i '-
`f 'N, . ' ^ i r--� �-
A I o . N FT
43 1 Z5 fri
--\\NNI _
a ` •
GAR.
�_ 1 STORY
Z • F�hM�H0. '�PflRCJi U .f I-
, iv
O
�rLI r _, 1j, '/I
UJ
\ __________________
It
\„\)",•
1 _o
11
In
1} N N
........r_./ Z ' „..-BULKHEAD '~
fi
•
•
h.7y`iS W. IIG.CS'=~1— GUf�,"'' 1.;' r
�, EJ TO r
`� / - - L!._ ,�_ _ I I 1.-!� ! 1_J ISN-s_ CON-1c,,,,". P�`{ �.NC
�. ' .- !-iii . , _ E-../-.'•;,,:•--
_ _ _n _
orDIhPSZY i11a1s j ` WATER. MARK' :. e' ,..._ E!/.,• ,i -- f,:' =..i:._'.'C.`'E L^— i'1l197
' UNAUTHORIZED ALTERATION OR ADDITION _____—__—_-__•__.v
F.ur.l i1v:7 fY..CbC) TO THIS SURVEY IS A VIOLATION OF �'-�t•�' �y C ��� i
SECTION 72C9 CF THE NtW YORK STATE ' I ( �%+%,
EDUCATION LAW.
aJY%�,.✓�z`f/ CREL k COPIES OF THIS SURVEY MAP NOT BEARDED / -
THE LAND SU:YIJC'S YINK.D SEAL OR .. I
&e: ,1_
EMBOSSED SEA. SHALL N..T GL CONSIDERED * LICC N o
TO SEA VAX) NUE CCP/. L A":..;A"� � �! f`,/r t
GUARANTE:S INDICATED HEREON SIIALS OM Gr-'E.`• i\, 1l1:. 3 R 1`/
ow TO EN.: A.::SOI.F.:R w.ICuu THE SLOW/
IS 1A4.40. A.:D J..HS G.HAIT 10 SHE
TRU CCurA:L .G::Y.CiJ:iNIAI.A &h CLI Ang _
•
tooes=4 INS:illaiNAl LSIZD HERLOF•AND
TO !!E ASST:, 3 EhT::s EE.nDb l(,win. i
•
TuIEON.GiA a.:.s AA war T4wdJ1M$IR . i
OWt J