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HomeMy WebLinkAboutWall °11" ®�� �.: ai JUDITH T. TERRY Town Hall, 53095 Main Road � P.O. Box 1179 TOWN CLERK EZzax rrt Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ` �•' �''�� MARRIAGE OFFICER Fax (516) 765-1823��® _Azg, 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. 1802-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner WALL, RICHARD Mailing Address 1 P. O. BOX 775 Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 2715 NASSAU POINT ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-6332 Tax Map No. section 104.00 block 13 lot 8.000 Cross Street SKUNK ROAD Date Of Last Pump Out 0/00/00 Issue Date: 11/14/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK ic3VFFCU( �'= Town of Southold : CG O - Application No. Judith T. Terry, Town Clerk . . Town Hall, 53095 Main Road v " z -� I $10.00 - Residential ✓ 4 . P. O. Box 1179 cn � �` $25.00 - Non-Residential Southold, New York 11971 O�l0 ���` Telephone j '� • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for, OPERATION PERMIT • SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /0 P-SLN { DATE • OWNER NAME: A a ki/OLQ- OWNER MAILING ADDRESS: P.m gox 7 73" // OWNER PROPERTY ADDRESS: b/ Ga /rl l d // 1 OWNER TELEPHONE NUMBER: C-6%) -7.31 ---6 43 V eedd%y /1/4'° /oo0 TAX AP NO. : Section /o a/ Block D/3 Lot ®a 7' A5 J('(4. /N'e r514/3bIr/Seorf y / 6 /j4/� /✓v ,co /or /® CROSS STREET: S/<u/.ld� 4/9--0 TYPE'OF SYSTEM: Septic Tank New Existing ' Cesspool New Existing ✓ • Residential ✓ Non-Residential DATE OF PREVIOUS PUMP-OUT: '4/94/6 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.) -«u-- Signature of Applicant RECEIVED, BY: Town Clerk's Office - DATE: - " 1 ... , n .M La i _ h r v �. Wit. v• '; .• .t*. t.SL , , El ,• , ,., ,, , , ,- -- , .`----4,---,...,Z) _ -T.:-• - :' e'. ' Ik.--_ .-- ,-.': ._ it. : ,..„,-.- cr, , _—, _ --- - ' ,' ,,-, •,.-' ',I ,,-, : ,_ , - ; _ -- 0 - , — . ,'. cl„ ‘ 1' -i-L--,- --, _- '.:; -' - - -,'. :-,-;'.'" ' ' ',LOT' =10 -' -'. ,- ' -'',1'... -1.: r', -';:-•' ' ,zi,,,-, --,,3 IA of -* • � • in - "`" ; :r ; '{eti � ; ' .I- -_-I • -, O ,, ,y; . 4 .I,-S.+,.1 u i � R� j � I5!1_ —' . AL1 � J°T ;, '- . ,. - r? s • ll = ;' 5:784 36 , W;;; ,1 9"*-1 ; .,, ; , ' , 3-ZO.,.J <4' ;,• �,; ;` • �. ;,. /.; W. ,6 i`•' .. I j �geiN4ae ' N , ' '„_ I' . '1 __4,,,„ . if, , _ : . LOT. 11 - 4I ' TE5-r” HOLE- l 1,, iy,� _ • - ' - ,— _ , /E•'' •.. •_ . ./ ?^r �_= 'I • _ ,(.MAP .OF .-PrOPERT' 1 - '• ' , _ , s -, -,-'- - — , . - r 'S 1 • U2V Y , ,w'- a S�rti� 5 { E Ei?a 51=CCL` _',�I It . ,.- , •Y 1: , . ,. _ .,_ .. _ - -. _ __ -,-' �;� . ' ..-' ,44 lI Rloca�ble vuells,Grd-�,:,�►aciIs fit'. - , ' L ' ', � C ,.-„,, y,�if•{tiKtQG7'"of; t►rdrsrti�e3 dr1�`,So,n+ I eAve S i- ;'' - , 1 . -x" r'.. NASSAU PoiN ' - - -_ - = ' ,.q + �. TOW+d QF. .SAtJT'HflLD ---Y".;•--"' 1 SE, Ir' I- JNAUMOLIZED ALTE2ATL.N os;AuDiT16_ ., v • ' 5 Cd�i; ' ,s`"` : " ATO THIS SURVEY IS A YIOIATION of ,i..„, , ". 5®' 4 1" L f(• , _ ,_ SECTION 7208 OF•THE NEW 11OSS STf,TII, - ra •= MOnutntfit -1 ' = IE EOUCATION(AW.- ' - ',' Guaroiitee41- -,to ,'5outhold''Sjvings" -Bartt4 . . g / ' , 4 '. '•COHHES OF THIS SURVET MAP NOT MARtN6 l. , I-6-1-, ` ,.- ; - -anal • i'•I Galt,Yti tt {'t ` + = .P 1 b(� a s y. THE LAND SURVEYOR'S INKiD SEAL OR , C.- �i f'E; d H �I 1�. 6N 6t 4 Ydr:G C Co, ' . i �r'• - �r�ciC v, I EMSOESED S(A)'SHAu r10T,RE.COtLSIDERED ai d SLlrYBIEc� f4 ' - ' TO SEA VALID EIME corr.. -, , - _-I, _ s :!a n ct l t 1?$. r af ,' ..'61$0‘001---, • .. iI `tlUARANi[FS INDICAf:D NEAEON SHALL RUN. A�- Th't'L; 4.-' Sl3 N — , 1' -' ,ONLY;TO.1HE V[:sON FOR WHGM THE-SU:MEY _14,oe L9 hunt t I f `L^'3 .'�r'O'N E 1 1" @ T"' 7 U:i ,`'ES PIIEFARLD:AND-04 H15 GJiALF FO EHE ' y^; ' "At'rt d.ridetd, it" A .4, c7`s c,4 4,4 l. ' - , .TOLL'COMFANY,GOYLINMENiAL-AGENCY•AND ? ' ,..;t. , 'r`.,. _ '� t C �dl n'tl :'z-�'akNDING 145111010H USD!) H.RLON. AND i w i ` J [ - A,.ill lti ",6uf tir,. Co Litt CI�;•4•K'S ,, ,, >it0''THE,ASSIGNELSOf,THELEMINGIHSTi• - 14( C 1v L.Qtici JUt'�GL�pE�t__ , ' { "' '- ., ON..LiUAIIANiLES ARE'NOT TRIWST(IAE11 " r--=-___-_,-/ _ - ‹=`�l'1'C , :OS :N<e1-la •No. - 1 S,b . ' .• . .. .< • Tr �NSTETUTEo,is•ciI►au+44Ea+4++� 4 . 4o 'd C HI)0 'f , N . .Y. ,� _� ' , TO ADD[T�fOM1R1 y y r v • j' I'•"4' _ I'I - .jY� - - - ', , t.