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Home My WebLink AboutWorysz i O JUDITH T.TERRY tt it Gym Town Hall, 53095 Main Road TOWN CLERK ; y P.O. Box 1179 v, Southold,New York 11971 REGISTRAR OF VITAL STATISTICS O 47$ Fax(516) 765-1823 MARRIAGE OFFICER ‘#* Os 01RECORDS MANAGEMENT OFFICER Q( ilig �aol�,� Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER =. .,,i' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3646-R Residential X Non-Residential Fee $ 10.00 New XIS Existing Name Of Owner WORYSZ, GERALD & JEAN _ Mailing Address 1 12 HAYES ROAD ' Mailing Address 2 City St Zip AMITYVILLE NY 11701-0000 Property Address 1 175 CLEARVIEW AVENUE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-842-8116 Tax Map No. section 70.00 block 8 lot 40.000 I Cross Street GARDINER'S LANE I • \ � - Issue Date: 6/17/97 Judith \T. Terry Southold (Town Clerk (TOWN SEAL) r , • • .,, OFFICE OF THE TOWN CLERK ,S�FFQ1k - Town of Southold �Q CQG Application Judith T. Terry, Town Clerk �� •� ' Town Hall, 53095 Main Road $10.00 - Residential P. O. Box 1179 cn �' $25.00 - Non-Residential Southold, New York 11971 �/�`� Telephone -:701 )\ ,',. (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 23519 /— Fee $ 10. On DATE 1t.Jd )9/0 OWNER NAME: - ---_ ,; -_-- CON..STRUCTALL .J. 44.1V• OWNER MAILING ADDRESS: ' . "P-4.44,-,-1 Z91.0 WICIFt OWNER PROPERTY ADDRESS: \Igo sz ` G-6 . 40-7s444.( FUu IA UPS-cam NA ►'r�u►LLEI IN ' OWNER TELEPHONE NUMBER: ( 4ftj 'S*. Q I RO TAX MAP NO. : Section 1 t .bQ Block Lot Lib •ba CROSS STREET: ic\-Ki)ltJ '_S � Lr\tJ€ TYPE OF SYSTEM: Septic Tank' New _Existing Cesspool =°tp NewExisting 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.) >e Signature ofplicant - RECEIVED BY: r T.n-Clerk's Office DATE: i ( • - -` I • •.� = _ .� a a. ,1.� . . - • • • yr . • i) T�►�e:E is nab sva-Ab.G.E' v.)e..T¢c� i -L ZOpyo1` .. WtTM11i 300 C•C• TA4.tS ACLA-St••• 1, E Lvs V 16.11.%u.�ag A S2 E 1'b.% 4 7. Sus OV�tt�tow� Z-!o~ SAAip`� `oO,!'� 1:j t.oe.1.� p ONty t„`. i� 3) 5VFF01.„K COV-,-) "r4 Taft, M pp otbT. “:1 Of* _ 6cc., 014,00 couTLSE ••• % et,‘,-14. 05.00 - Lor O4o, oao 8-3 S 4n+p 4.0r `��• � T '"� tom` % ' P LlSkot,11•a Is w t'Ctg • v wZltL •�IE.II J - Rbg �. , M `ate b � (""° a v".�a.s a► : Cit. "- . . D �Z rib.. • • `1 p -,meq �f k..4. 7. • a ~erg ti. +-`�' / a I.• 1. I-. Q Z�.83 M !' rte R. Rt Y. ,,>j �. ir J � wR 1T�.r�s,- Q ' •ot S��E .i 01, A1• h a° t f S+cist at j I 1 co.O . 7 .>�`" ei,) , il* „ = f 7 .. -., '. .. Nue,..%. fit` 4 :I.% _ i ........ .. ___ : i is , _.-, :,,,.„ 7.-.:et ie._ ,...,..,‘,..s.:- ..7• P US X, O. ,� T Y. a - I. t .ii! , o +°x,;s • re+ Q r-.., Q 0 ;: O (jc '� �J t� ST r-s ex t� - } ' A'pi NO•OAC) ti3O + to `iQstat''`v '� F�► j tem, '; _ _ _ • f_aT * t g is P\-I c Awa • I A 1-t t=a M 1‘....1 cc► w AT�t T�t E `L Z aPpRe�IAt. aR- Pa,.'wasS STL-T ..•A.RQS ay Obs TlOe4? © C "SEeTlotii ofl+i�- ci�t'Zi+.R� wO�v 'S 1_ "-�te►D God�ZRA�e.�ees::-. }_ F a.V t e,,\ea Piot Pow` 4 ce.t-t1t P`0.4E Se ►•iA(As o1sPoSR` 3`r%TSMS Foto. siaitstE- ai RILE 3388 - CtLEO Atstt,q t�i(�t AfitCYV tt.1E i�1`i 111b1' AK\`Y RES\orT..1 c-C, S" AwtD U,i1t..t— Agtps t S►TU U.T 11...r. P1t. 842- gttCo BY Tvtil4 C.orN py�r'io�+S SST Po12r1.1 s♦16Rstes `*C)l...11-IA 4 -- UNAUTHORIZED ALTERATION OR ADDITION ��D O T.4.E. P est.M LT 'CO Go►.�gr Rye„T•,Ii . -r014 /'� F S . `Z ®� TO THIS SURVEY IS A VIOLATION OF Np cal„..,‘c„.10,4,i-(5 g`414�,e V�� F V u ! SECTION 7209 OF THE NEW YORK STATE - ? - S U F c CA.V. C.o U�'�'.�/y t, l •'1- EDUCATION EDUCATION LAW, ,�. 4�- �Y COPIES OF THIS SURVEY MAP NOT BEARING - _ fS - THE LAND SURVEYOR'S MID SEAL OR U V e y e D +{ EMBOSSED SEAL SHALL NOT BE CONSIDERED r Y"a-46...�.r t g x K 0•��.•‘....S. TO BE A VALID'TRUE COPY- _ Z" Q V.A.�� GUARANTEES INDICATED HEREON SHALL PUN 1 p _ ONLY TO THE PERSON FCR WHOM THE SURVEY - }i- t✓�V� P_ O%NeS , •"I• ties _ IS PREPARED AND ON HIS BEHALF TO THE 'i TITLE COMPANY.GOVERNMENTAL AGENCY AND R Q♦4 E !-1.,va 91- ��V 1to3-te.!p 7•' - LENDING INSTITUTION USTED HEREON, AND VS a�pL t N a'4 Ot p A'T 1�APL Z®' `�®4:17 THE ASSIGNEES OF THE LENDING INSTI• - +>♦ S. O t.7 T P R�Pp SVs• ;kit b , NO�' `,-1 iQO,N• GUARANTEES ARE NOi TS L.RA9tE _ ' Lc"a AtE: iii 5'. U►.L p ESL �A1!*Ice., O er,C. Z q ERS. ONAL ;rslT .I,rs OR s �.eo;T,. FttaAl St�R�/ e..-AC ►'1 A.x- �v, \Rq`t �Co OWNERS. CO?ARm.JTE.E� - -0. �'IERA�� 4, .SEAN wv - To Ft Ft ST ' �MR:ttp,IlJ TtT1-E lt.-1 g. GO, of 1.4.4 • • • . , ASE ' a 2-Ct, a. :G S '- .1.______.,-. -......_,‘ a .