HomeMy WebLinkAboutVan Workum •
JUDITH T.TERRY ® gra � Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
P � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER `� � ' Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER : .0:000Telephone (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. 3683-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner VAN WORKUM, JOHANNES E.
Mailing Address 1 760 OAKLAND AVENUE
Mailing Address 2
City St Zip STATEN ISLAND NY 10310-0000
Property Address 1 855 GRANGE ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 718-447-3867
"O
Tax Map No. section 75.00 block ---4 lot 3. .OU0—'
Cross Street MAIN BAYV I EW ROAD cr
Issue Date: 9/04/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
t "
OFFICE OF THE TOWN CLERK • FULA/
Town of Southold �� rx'' ,, CSG= Application No 2 C 3
Judith T. Terry, Town Clerk
° { , y
x < $10.00 - Residential v
Town Hall 53095 Main Road
p. O. Box 1179 tri $25.00 - Non-Residential
Southold, New York 11971 O .' _
;P,-
Telephone
Cpl °.
(516)
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0, CO oo
DATE /90640.20 • /?,97
OWNER NAME: � /?/1//L� '-S / , f// '(/6) /
OWNER MAILING ADDRESS: 76O e. 97\ / '/ L? "c2G74-:
3?/y%civ 4/13, /1/1 /0_3 /0
OWNER PROPERTY ADDRESS : /9/9/1/66. - ele0nz-�
SroU7�f(��.473, ,V2, /72 7
OWNER TELEPHONE NUMBER: (72'Z J e(7 —3357
0.d' sour-7y ff/i /2
/va. 70 TAX MAP NO. : Section O'73-0D Block a G"®62 Lot / a
CROSS STREET: ///`/ /V //97 2 /E ,(/ 'QO// D
TYPE OF SYSTEM: Septic Tank f/ New Existing L/
Cesspool `,�, New Existing
Residential G' 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.)
/11111
a/Ca--
Signature of Applicant
RECEIVED BY: . 4J/_✓�_
To Clerk's Office
DATE: e7 �
1 SUFFOLK COUNTY HEALTH DEPARTMENT -
30 1973 H. D. REF. #��
DAT S
The sewage disposal and water siinp1Y - ROAD
facilities for this location have been :
. inspected by this department and found -
�ln-
5..95009'50
647.93`
to be satisfactory. a. (J� S 8500950 w! .
Chief of General Engineering - I
Services ( o125p R'1981 -
G 1. o 3. t;
P� rah ,
-
`i n 99' \%,
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11
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�, y s ,.Isfi96.' NOTE
Z .' r ®=MONUMENT
o o `Jrd 4 s OSF NEC R/YOMAFSU FOLK THE COUNTY OFF/CE
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��, ��' JULY/4,/964 ASF/LEN_O. 4096.
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REVISIONS
,s ''- F, n YOUNG YOUNG
o:fs •
Co _ y - Z"___f f`-'s ki MAR.30, 1973 = 400 OSTRANDER AVENUE, RIVERHEAD, NEW-YORK
, r
,- a 5 ! ALDEN"W YOUNG_.
�. /24.4--_,Ir
.`-:, '•' =- HOWARD W YOUNG
---------
028' 5°03 5i ��souf/�e-/Y /i�r of int qJ ..11,0,-,,Ifo�,O LANDESURVEYORSSIONAL NNIY SE ENGINEER
12845 - LAND SURVEYOR
�� of bow
` On f,/Ed f top of south y N Y S_LIC NO 45893
., _ i•,a r,.�y12ED ALTERATION OR ADDITION SURVEY FOR: - - ,=
now 1/Q�mer�y 7 C710` T�R9[CFSTHE NCW YC RK OTA7E RENE GEN DRON ' _ == '
B tepnoski t`L ""v" L LOT NO. I3,'ISOUTH HARBOR HOMES 'I %`� _
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Y /:A? NOTo
BEARING 7� _ -.V'` =,' h.\
_ _ _4 •1 uC CONSIDERED `' ~, !•,- y `�1`
f+ T� FY E AT GUA �AITEED,` Oc
• GLA E ., SOUTHOLD 7 y I „ _
'=- C it TC :•i - .A-O. SHALL RUN;1:P:
. _ _ ',a'1 - I' -�..-
5 : _ , F THE SURVET-) TOWN OF ( i,
- T!TLL C'_., n " L' -LF
1U FHE ' SOUTHOLD - \ ,a :\ !
: - - -LU.LI.!': I _ L A_ AGENCY AP9_ \ ,'11, '
TC THE ASS . h-n-ON,-AND 6Y P ` i^ �.� i
SUFFOLK CO,, N. Y. �•l' `•
ti • i6liU:� C,. - Ir,E Lu,CIG IN571- y �_ -,
--' AB.�i.ic'S A.I. NCI T,-ANSFERABLE /'Ofr �,i', ✓/f
" . TO AU.:11UrvAL ,n5111 U1101.5 UR SUBSeh2UE1Jf; SCALE _
it; Owt.L, I rr = 40' I DATE OCT \`'-. ��$9 -
• _ - o_ . .— . 25, 1972 -- 2
TIFT7GFN Ii5 11946 _I