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HomeMy WebLinkAboutBrock i i tl u ,Wt ® Town Hall, 53095 Main Road 14 P.O. Box 1179 ® ,•:)) Southold, New York 11971 JUDITH T.TERRY `-_ � " �' TELEPHONE < ��10/1',ii� (516) 765-1801 IOWN CLERK REGISTRAR 01-VITAL S rATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 872-R Residential X Non-Residential Fee $ 10. 00 Septic Cesspool X New Existing X Name Of Owner BROCK, EARL D. Mailing Address 1 585 INLET VIEW EAST Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 585 INLET VIEW EAST Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-9381 Tax Map No. section 100. 00 block 3 lot 10. 009 Cross Street HARBOR VIEW AVENUE Date Of Last Pump Out 0/00/00 Issue Date: 10/04/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) A D :• • . ,r I VI. ]` OFFICE OF THE TOWN CLERK Oc3IF U( #1• Town of Southold 0�% re % Application No. �7� 7. Judith T. Terry, Town Clerkit'-. 1.0 $, ~ : y Town Hall, 53095 Main Road a 4.-N,- s'c -� ) Residential P. O. Box 1179 u3 ' 14.i.,:441',4.7h�i � �...; ,� �Z Non-Residential Southold, New York 11971 O ' `=- '`�' . ' Telephone SQ/0.41,- 1 .0%, Er f (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /e5'. 0--6 DATE /eVz/Fr OWNER NAME: ..:;9/2 . - _ �/e©C/e..-- OWNER MAILING ADDRESS: _s SS- /iy/ v/ G` .---- /'.4-v97-7-% /u7. 77 7r e-e- Ah /.- // 9S-r- / OWNER PROPERTY ADDRESS: �i'9nfie- ,/4-5 ,,,0 --e.,4_1"--- _ OWNER TELEPHONE NUMBER: X98- 9) 3 P / , TAX MAP NO. : Section /fid Block 3 Lot /D-P CROSS STREET: /L`� ,1v 1- t) r9rz TYPE OF SYSTEM: Septic Tank New Existing Cesspool 1/ / New Existing Residential °� Non-Residential DATE OF PREVIOUS PUMP-OUT: /7+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.) df/ Signature of Applicant RECEIVED BY: oe. .64�� C -r REceT �lLQlerk's ffice DATE: - , u`7 0/', E2C,; Town Cterk Southold ,....,.0. • TITLE NO.'•78-0800748 .1-_ '_t, ` THE LOCATION OF WELLS AND CESSPOOLS.SHOWN HEREON ARE FROM FIELD • • _ , ' OBSERVATIONS AND OR FROM DATA OBTAINED FROM OTHERS . - ' THE WATER SUPPLY AND SEWAGE.DISPOSAL SYSTEMS FOR THIS RESIDENCE ' - WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT ' • OF HEALTH SERVICES APPLICANT:,_-____— -- , —_---- - ADDRESS . ' • ___— TEL,__-_ . , B0Rv • : • " ' NAR , • • y' • • • I R, \ r I i7/. 4.. , k:4-„, • . .,, , ii. .....„ , . . . , . .,., . . , .. , . . . . • ' . .• , 11 7 o W M , , 93 • • „ a z Lot 8 t •L i'. 3 rn, o }y „ ';', ' 4 4ot ' 9 , - , L, . - • • o %r ,79052 3 nE ,rte' i.. ,1,';.;'i .\-, ,, • �- It •.� , ,'1"'^,1 �, 'M1 -'.Ir•,.,^ Yitl �,,' .,..��• .�f,,' /•.•' / / `f r•/ , _,.. _ _____ O _ - IV - ,--- M . -1-7,77•17,-;:-.,;;,t;..._. i,..._._.-1, ;:7-T« , - (�"'-F ,irkei+jt-,"'," .,'•;-,1- Viw Sr-F--,^:-:: n' .,'r•';i.:'__ _ o. EI•• 1 `• - er ',a' �i;,(•r;rw_�,-. L t 'j,i•`,4i;..-, •- t 1. sci `.— Q_ CP. 5T. 53' A 4,4 r, M ��/ - . I.,0 ' / • `'-`' p•23.0 /'/, 2863 ' \ • • ' • 14 p �� �w Um • . ' , y O • i' 110 I �� t \'„. • eL°�'Z 5.75°58 `Areo - ' .. ,,j` „ s\.:..\N,,„........._ a Re ---,.;i: ,:•-,'7'. • • r1 , -------\- k. pork 11 \ s •NOTE . . • ..,; ;As.,' : `'d 'r:; .' _ • , • MONUMENT • , ' ,. lr j. ,•... ?i 4 ,:'i., .t SUBDIVISION MAP FILED IN THE OFF/CE ' • • ' • is `' ,a -? `'- r .�;;,, "` OFTHE CLERK OF SUFFOLK COUNTY ON: • • MAY/, /975 AS FILE NO. 6249 r..,; -, �,.;:I '. .,.';• '4. ;�;-'' - . ", -THERE ARE NO DWELLINGS WITH/N 100! - -_ rl ,. . _"`" ~:;:r. ..; ,tla,Y` --, _,-:•"`., - 'OF - _ _ OF THIS PROPERTY OTHER THAN THOSE = I'".-'•-••----4,-,..'2'2"-'-'•-• D W a SHOWN HEREON REVISIONS vYOUN'Gi4i: ;YO .:N PR 1- I WATER SERV/CE;-PRIVATE WELL - MARCH 30,/978 • -400'OSS'•'RA'ND`ER'•'AVENUE,,',RIyE' VE D� �!i" •RK 2 - ' -• SEPT. 6 /979 • ,' ,I''-• '' 'f4,:,;•,,,:,;;