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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK N
�`� � P.O. Box 1179
®
REGISTRAR OF VITAL STATISTICS , �. Southold, New York 11971
MARRIAGE OFFICER O X411' Fax (516) 765-1823
e® �� - Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1827-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner VANACORE, RALPH & JULIA
Mailing Address 1 P. O. BOX 121
Mailing Address 2
City St Zip MASSAPEQUA NY 11758-0000
Property Address 1 PLUM ISLAND LANE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 15.00 block 5 lot 3.000
Cross Street RYDER FARM LANE
Date Of Last Pump Out 0/00/00
Issue Date: 12/31/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
�I. -
OFFICE OF THE TOWN CLERK �cvFFO �'=
(�(�
Town of Southold z% ; ()AN Application No. //a-7
Judith T. Terry, Town Clerk W �� `'7 $10.00 - Residential
Town Hall, 53095 Main Road
p. O. Box 1179 cni ' $25.00 - Non-Residential
Southold, New York 11971 O ®. �
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
— f
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE G'o// q
OWNER NAME: tkin ACCKze Rgp '/ 9 cJ7J<- •
OWNER MAILING ADDRESS: Po 66)( /oL,
1 AL /7615
OWNER PROPERTY 'ADDRESS: PV
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 1,5.- ®O Block Lot 3 ,.
CROSS STREET: , ,� to.e(R• LoM-e
T-YPE .OF SYSTEM: " Septic Tank 'New Existing
Cesspool New -)C Existing
Residential 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.)
' Q
A-Y16t/N
Signatur of Applicant
RECEIVED BY: - -
• ' Town Clerk's Office
DATE:' • ' Q�9
DEC 3 a 199q
'Town Clerk Southard '
ggaNy_Lautay nEpintarNT OF HEALTH SERVIC,.,r.; ^ _
• FOR APPROVAL OF CONS 1 fIIUCTION OF f - SUFFOLK CO.HEI
S:ngle F,m:ly-E.F.'ci iIL e 014 , • PLEASE NOTE H.
,,111. 4.1?! q1,S!�_ Minimum distance between(wede Nr)_ _ �, -
rPnavEo _ ___ _/ �� ......
and cesspool is to be 150 feet.
i _
EXPIRES T•i tt�S FRliiv +_ PPRO'JAL 1"`� �_ I N1AP OF (_�I?OPEI2TY
' ono ? • - • f_._
aUkI YJ LJF�rraPLUM. �13L/�I�l • I j1...JL.. 11\,
-1- STATEME
I.AN� 50 THE WATER SUPPLY
'SYSTEMS FOR T'
ANN A�\.54715'50'E;:,` 139.76 -- ` -- - - �- - - CONFORM TO THE
c012:4
` 'P2t PitOV. :' i Ur�y1C+,�{ SUFFOLK CO DEPT
1.96 �p>G w��l: I Q, •• t � ISI
R
I I" A.i" APPLICANT
.
• l\ Iii „ • • soya' ORIENT SUFFOLK COUNT)
1.11
• -+ % i I I' ��- 25 �--_ - �+Q�l�l'J OF_ Y.Ji�i i U J�1.�, SERVICES - FO
, -°(1... , ,.k• „ r , CONSTRUCTION ON
• \`�� DATE.
�, - H.S.REF.NO,
' 35 - of MOP. HO. }-: -352-_. -
APPROVED
LUr 156 • m — - 1 @ACAur) -
SUFFOLK CO TA)
(PAGAN?) Nt 1 p_- DIST --SECT
�\ Zb fS c I . 1.1' ' _. ... t , `2; r,, 1000 015
_11Jl51 1
Ir,: y "' yl OWNERS ADDRESS
N I /v A) ' /J,.a.,, �,�^„�- �8�SEP,
• N \ i �" 1,,J ASS A P€ ,
ritil.4
. - 1 \kb= ‘-
N,88 57r40.\•J'. ' 139.70 /_f A2EJ►,'?1,J4C�S F. DEED L. N/A
i f
• J.y5 U'I2ON PIPE TEST HOLE
iri i 6/AtANT) TITLE' NO:i'21.-5-35a13 blillagitti I31y.N Clii:i
•
LQT160, .':, LOr i61,(IzEsI 1 tvCE) rNCH l�UMES, INC.
1775 ROUTE 58
;r • )4 'y ° e� IVERHEAD, NY 11901
` ave`x ' '15160 727-0221• _ I
• 'L "i1Ai'•UE ORIEh:; bpi rE{E,ciA-SECT, 3". , :L)FFCO. MAF NO.61C�0 -••-1 r\ - Ui
" ' \ MAP AMEHDED-JUKI27,;9 I;-!ul.YtO,'91 Li.
i� ., �: WELL COVENANT REQUIRED I~•�� ------ - u _
PRIOR TO FINAL APPROVAL. . CESSPOOL/ (� U'
. I.LOT N05 et-TOWN THU '15 !<f_r 82 TOMAPOF'02IE`JT BY \ '• :aoA 2h?_yT'E E.i; )L {
The 5EA-51 Ct ^c;FiLEG IN Iii(«.s.,L)EP �L$12tt•% -. ' - E:II.c5TT..AMEL2..i*4,1!TI i'L.E IN.,.)Id.,�'.i ., w
A:3 R PtO_ '• � ' " -� CON IPAIdY =_AG f3JJf_'Vt_Y D:AP(2.IU,19$ i-
Z.S�!?FF:CO.TAIC MAJ� Asil ,I( r' • ' • RODr1:RICK VAN TUYL.P.C'. 1
3.COM'AUR 4 ELEVATIONfLEFECI TO j�E/�1 5E1C CEVEL, r.. LICENSED LAND SURVEYORS
—
y • . SUFE'', CO.L'.R I.TOpO MAP. • _ : • .,._ GREENPORT ' NEW YORK