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HomeMy WebLinkAboutWilkens ✓ Y t : 4 : F° JUDITH T.TERRY G'f11 Town Hall, 53095 Main Road TOWN CLERK o - P.O. Box 1179 � Southold,New York 11971 V O REGISTRAR OF VITAL STATISTICS �� Fax(516) 765-1823 MARRIAGE OFFICER : y N �/ RECORDS MANAGEMENT OFFICER ; ol �� ' Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER a�,it OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3611.5-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner WILKENS, WAYNE Mailing Address 1 P. O. BOX 1913 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 385 CREENFIELDS LANE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-1565 Tax Map No. section 59.00 block 5 lot 5.008 Cross Street TUCKERS LANE Issue Date: 6/11/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) /IOS IL. OFFICE OF THE TOWN CLERK 3 6 vr Town of Southold �% eVt._\ No. Judith T. Terry, Town Clerk Town Hall, 53095 Main Road -4 $10.00 - Residential ✓ P. O. Box 1179 u' �o $25.00 - Non-Residential Southold, New York 11971 O * Telephone 4fQ/4 l�0�/ (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT • • APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE ,KA/7/9 <7 OWNER NAME: /Z,,✓ tr' 67t& OWNER MAILING ADDRESS: / ( /5273 (5-70 r7 OWNER PROPERTY ADDRESS : ✓ �` c��°��`/��`�/'��,f [ �C�' J;vhf OWNER TELEPHONE NUMBER: �65 - /57i TAX MAP NO. : Section S ' Block Lot CROSS STREET: %(JC,e /' � ✓.�/6 TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing t/ Residential 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.) ignature of Applicant RECEIVED BY: Town• Clerk's Office DATE: ( CG M r Y J _ `' , •_ ,--.,..-i,+ •`i'_L`7 ti _J- 0,1. 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"} ,"`:4t;i^r ,�� _i : �t F ` ,:•, wrt r,,',-•A7{.j.•i. i'� _-f• ,.: i.,'-.4,,..""T''',1-i",---V-:;',,t-,4''' .T"ak.q.;.-'. 3.` ,•t�4� ,-• - _ - Q\ COPIES OF THIS SURVEY MAP NOT BEARING' •" r' £' I '"' - rt"1. .r +��' "�-�•r=`J", LI- 1:•t r*a-'_,� t�' 1 a s' _ • •k.+ _ �T THE LAND SURVEYOR'S INKED SEAL OR - - `� :�yd ', a ' `� ', � �� `"`" .. EMBOSSED SEAL SHALL NOT BE CONSIDERED • V- • .‘„,-":•,,:r.,.:,, ;,•„ tY'. _ i iw f TO BE A VALID TRUE COPY. :9 i ia::r `` 'fes^ i;,-,_-1-,-....,_.4 ti-4..,..3,,-4.�4, f• ' • t 1 GUARANTEES INDICATED HEREON SHALL RUN �' - S .� .!Sid�,'r`";,` "y"(EI-„f;c�, -..^,..&.41,-,0 .r - : ONLY TO THE,,E-S0,4 FOR WHOM THE SURVEY 1 '.,•?I • - • _ tt':•t '';.', •'1 ' - _ • i 6 IS PREPARED,A,-D ON HIS GHALF TO THE _ - - IL:71 _-'---6?", j ? TITLE COMPANY, GOVERNMENTAL AGENCY AND + _ •' II - 's,y y 9, "?- " •• ' T',/ 1 LENDING INSTITUTION LISTED HEREON,AND 'I• _ = I''f 4 '�� ":c„,,,,-':-•'' tJ'r•'S,1 i""••;� "_,};" -, r. . r T' yet TO THE } l - •_ - ---- t- 3° -- -;�f'r:1-•!'-'-'" "` �' _ - v ASSIGNEES OF THE LENDING INSTI- ,;S • ki�`i_:i•- ,,f.,;','° .p• N, -. • -, ' ,��,� TUTION GUARANTEES ARE NOT TRANSFERABLE • �, ! .f •:"S-' �tt'r,.,$; 'r'.�%.r',�- ,0--0;•-•„-,,•-•''-, C;�'ti• ,~`` II TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT 1.' _ - .+, -„`',",,-.;!..'/-7v.- •' 1.)- 1-...;j n'•r:.'.1 )'1',�• ; 7. ;"i`11,•.)-ti-t 11r- .* r a3, c• -:l'. '.�. ' - •S_ h. OWNERS. -. 'U' „ ��Y`:•'.' - ="a5i''' „r•`;i.�,I N r.-:"`","1- ,::.• ° 'ry �"tser t,x,'.+,f',- .= tM- -� b ' '1 E'U - ! _ S'r:^1"�•,-'t; ,J.: -.`}�!�-h' -‘ •`. •!