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JUDITH T.TERRY ,� � ��; Town Hall, 53095 Main Road
TOWN CLERK ` 1 P.O. Box 1179
V.16
MARRIAGE OFFICER � t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `®41 ,��� Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER 4)1 `�`�I" Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER �' ,0"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3507-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner WITHUS, THEODORE H., SR.
Mailing Address 1 P.O. BOX 904
Mailing Address 2
City St Zip MATTITUC NY 11952-0000
s
Property Address 1 680 WESTVIEW DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5174
Tax Map No. section 139.00 block 1 lot 15.000
Cross Street BROWER ROAD
Issue Date: 8/29/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
ti
OFFICE OF THE TOWN CLERK reFO s7
�
Town of Southold �0 > %. Application No 's
Judith T. Terry, Town Clerk .� � hF :1
Town Hall, 53095 Main Road I $10.00 - Residential
P. O. Box 1179 cn �� y'j �' ' ` $25$25.00 - Non-Residential
Southold, New York 11971
Telephone 01 1%o�'��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE U 2( - 4
OWNER NAME: %ff7IJO1LG= fE 1) T- LL5 U r.
OWNER MAILING ADDRESS: 1?d. Pc, ,& 904
•
M 747-7-/ e- K.
OWNER PROPERTY ADDRESS: 10 •Wt-275
r- 7-'4> (y `1,
OWNER TELEPHONE NUMBER: 2cj '1
TAX MAP NO. : Section 47 S)IN Block f 3q Lot I
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
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.)
• _Sign. ure of Applicant t
RECEIVED BY:
Town Clerk's Office
DATE:
TITLE NO. S-393645,
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i•" "T.': COI:':T� I:rx.LTH DEPARTMENT
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ELEVAT/ONS ARE REFERENCED
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REVISIONS YOUNG & YOUNG
McQ.ia,is73 400 OSTRANDER AVENUE; RIVERHEAD, NEW YORK
ALDEN W.YOUNG HOWARD W.YOUNG
PROFESSIONAL ENGINEER AND LAND SURVEYOR
LAND SURVEYOR, N.Y.B. LIC. NO,1284E N.Y.S. LIC.NO.45899
UNAUTHORIIFD ALTErATION OR ADDITION
TO THIS SURVEY IS A VIOLATION OF SURVEY FOR:
SECTION 7709 CF THE NEW YORK STATE -
EDUCATION LAW, ,
cows OF THIS SURVEY MAP NOT BEARING
, NICHOLAS BRUS •
$ - !
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THE I.A.D SUPVEYUR•S INKED SEAL OR •
EMBOSSED SEAL SHALE NOT,E CONSEDERED • . V O
TO Ef A VALID TRUE COPY , •
GUA'ANYEES INDICATED HEREON SHALL RIJN AT
MATT/
/� - GUA- EE•��-' Et O o
ONLY TO THE PERSON FOR WHOM THE SURVEY Mf/T/ /TUC' I >
•
IS PM ARID, AND ON HIS f[HAIf TO THE - SOOT;Ol.1 S S T .L,,- '.' iyyyi,i,,,, y
TITLE COMPANY, GOVERNMENTAL AGENCY ANO
TOWN OF SECU'( 4 Tom`• ir� AN O.
TENDING INSTITUTION LISTED HEREON, AND SOUTHOLD \` .,,,
E0 THE ASSIGNEES OF THE LENDING INSTI- 90•
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SUTTON GUARANTEES ARE NOT TRANSFERABLE BY ,,�r li 'S �,O`
'O ADD;TIONAL INSTITUTIONS OR SUBSEQUENT SUFFOLK CO., N.Y. ��/,� 1�+
'i + • „ `'. SCALE: is a 40 i DATE: NOV.2 1972 � `� • ••-