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HomeMy WebLinkAboutWalters yf,/7L Co le,o4N‘ JUDITH T. TERRY . ` Town Hall, 53095 Main Road P.O. Box 1179 TOWN CLERK LrZrt tai REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER / 44 Fax (516) 765-1823 'eas2 ®ill 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. 1965-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner WALTERS, DONNA M. Mailing Address 1 10105 OREGON ROAD, BOX 160A Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 10105 OREGON ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-6398 Tax Map No. section 82.00 block 2 lot 19.004 Cross Street DEPOT LANE Date Of Last Pump Out 0/00/84 Issue Date: 8/27/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) • OFFICE OF THE TOWN CLERK 'c��FFilter" ff / Town of Southold � CQ Application No. G �S---1 Judith T. Terry, Town Clerk air 1 Town Hall, 53095 Main Road F .. $10.00 - Residential P. O. Box 1179 �_ ' ` `• i ` �„d�” $25.00 - Non-Residential Southold, New York 11971 O ®, •�r ' ' • Telephone �l Y► 0 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE 6Ial 9.. OWNER NAME: I©l1lO ii - Wa 14crs OWNER MAILING ADDRESS: IUio3 CQre(9tn /a0 d_ 80X 1(o,1 eu,-1-Ciit9 r t l�1 N t l 93 - OWNER PROPERTY ADDRESS: Str OWNER TELEPHONE NUMBER: 5/1 -734- (039t TAX MAP NO. : Section 3 Block Lot / ?- CROSS ?-CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing ✓ • Residential +/ Non-Residential DATE OF PREVIOUS PUMP-OUT: 198 7 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.) Signature of Applicant RECEIVED BY: Town Clerk's Office DATE: • • y -1..�< ", s 3S"..?,is F >4..�c.•'J ;.J. �.fi= i.;�� ._, � ,:, .1'.4r'. A54r::;;•��:�i'y.t``:1�•^'°•SV,'S``a-;',' \3 B l q,tii'Y,��'za_•:x .LL,y srr-.•, idi',".a.4.ts:t`,.',. a.•yr::. kg'.: rey'.11:2 e-n. 1k-O l'f` r-q* \• n� - " _ • • - _ ,'Z't: J !•,r,••,itz•' ill's. :4i-`,• ;:, ':1 .c•:' ,,.'✓%?-„4„,.'a ';i•y.-\,W,4.t 0...i N ^,L:$,�w, tl-,' -'\':' \57 • 61'•,,r• T • - t iI,`,-..,-va`A,5e:+ #„'4;ae zi:7si_;-A'ri"i}Lx3ti]1'',•.S`Tr-c:,t¢+-'i9[',?;c.`:� c+.� .,,,,,1,-,1„,44,� :•• 'n. s'4.ft, '',�•-- ` , N r, �o .:'' L•-„'�OS.'s c r'i', , 'r;-4.',i' ]I •"a,x ,,,.Y"b'{,`y�'2.`,�°«u'tr,. •+ ,, 4•..z.`..t'..-.�;',•C:'� a;, :;Jy.,t;. 4' '•'g-;a , ._ , - 'Z - - A v, = 41` ,? ,t Y Z�„aip r'�.Y, ,', ! 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''.�'^1 .:4).�`-•` -` ;r/.i `�, , ` • ll A .. 77 ;Ye a96F �n y Oby I (� I M 5C G ' O .:i S: . i'.' • „.,..,!‘,..1; „,,".0. fyX.<'sy`s• `' b. •t.,'Si � 4'1''h0 5\IJ 4 ''r �;ts" -:.•: „Fn.',� r , ,; .i.'... ?�zr,J�• �'; ••T wy.�J�•v+ia,� yet-•-r, ,���,5�4:Z: `ti',' l\4 00 • % ' '1 a�,•F!,,,L,., . t'... , .,;..,,•�.'+2 u1;:«oktit'rl':3; . . . . ....Jr. , ‘i " ........"...j;. 1 _... „ . . , , _. _ .I14, • -.. • • _ 0.- . ._• `..,' • 'V . ' • 'a ,�ri y, I , - Jo • �, . ce0 M)�� �0 - ;mo 's _ -- =_ = _ _ __ tz• it N - o • k 5e �h o • .. - . 11•••‘10- ski- rye. • -� ('�• G of �• CO• TES T HOLE � - , T 0 s/a,�dy. • DIA tQ.. • cam,^5kg` Gl — 3 G - �S 'C _ • NOTE 2 �6 • G', �,1 = MONUMENT. — l�.o . -P • NEAREST• WATER MA/N.= 5 MILES + - - '-- • • _THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD ' ,! O S�P. •�' • OBSERVATIONS AND/OR FROM-DATA OBTAINED FROM OTHERS. • . REVISIONS . ' 1- ts1, �IN (GG _ YOUNG & YOU..: G; ASD ,w o�, THE•WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL - ' ' ' Ag Q SEPTI�T /97G' 400 OSTRANDER AVENUE, RIVER EAS, NEW ORK"? ti` 1' CONFORM TO THE STANDARDS-OF THE SUFFOLK COUNTY DEPART LENT OF HEALTH • / '' ` OCT /4' /976 i2 ' . SERVICES + ;' • - , - • • - , ALDEN•W. YOUNG -H W.' •UN. APPLICANT - O / .,;' • PROFESSIONAL ENGINEER AND, LA Dl v• EY� i - - - 'LAND SURVEYOR, N.Y.S. LIC, NO, 12845 N. NO.'4 •=A�3; ADDRESS— —— — —'- - -.- - =.--- — • � ' % ; • ti SURVEY • ' FOR: ,�,G 4 _.3 �,/ -- - -- - - - -- - TEL -- - - - - — - - . o.l ,. _ • UNAUTHORIZED ALTERATION OR ADDITION TO _ - '` - i - , THIS SURVEY 19 A VIOLATION OF SECTION JOHN J. WAL'TERS DONNA M. 1 -. 7209 OF THE NEW YORK STATE EDUCATION • - • IUD SllR��•40� V - COPIES OF THIS SURVEY MAP NOT BEARING o• -,.. - - „ . THE LAND SURVEYOR'S INKED SEAL OR _ • - • • - - - . EMBOSSED SEAL SHALL NOT BE CONSIDERED - - J ' ' - l _ TO BE A VALID TRUE COPY. - - ' ,pT - - GUARANTEED TO: ' _ _ - , _'- CU TCHOGUE. SOUTHOLD SAVINGS BANK _ - ., ' Q GUARANTEES INDICATED HEREON SHALL RUN, - AMER/CAN TITLE INSURANCE CO. _ ONLY TO THE PERSON FOR WHOM THE - TOWN'OF - - - • - C -0 SURVEY IS PREPARED;AND ON HIS BEHALF I J OU THOL D • O _ TO THE TITLE COMPANY,GOVERNMENTAL ` •/ -�,1' AGENCY AND LENDING INSTITUTION LISTED 3 BY / /� ,! �� HEREON, AND TO THE ASSIGNEES OF THE I SUFFOLK CO,, N.Y. •bl,! C%�Pa V • - \' LENDING INSTITUTION GUARANTEES ARE . I NOT TRANSFERABLE TO ADDITIONAL I _ SCALE: rr= r DATE: NO. - - - INSTITUTIONS OR SUBSEQUENT OWNERS. / 50 JUNE/7,/976 76-458