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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® ' P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = eY ���` Fax (516) 765-1823
MARRIAGE OFFICER `-® ®��� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER _7®� 1114 ;0
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3243-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner BUHLER, WILLIAM AND HELENA
Mailing Address 1 1080 GRANT AVENUE
Mailing Address 2
City St Zip PELHAM MANOR NY 10803-0000
Property Address 1 2455 CEDAR AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 914-738-2573
Tax Map No. section 77.00 block 1 lot 17.000
Cross Street BIRCH AVENUE
Issue Date: 8/29/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c�VFFD(,r�
Town of Southold � C• Q ' Application No. 3,�y3_
Judith T. Terry, Town Clerk , 7(,
Town Hall, 53095 Main Road � :-� .G $10.00 - Residential
P. 0. Box 1179 cry 421. • $25.00 - Non-Residential
Southold, New York 11971 0.1o�•�`
Telephone _
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE g k q
OWNER NAME: Li AA -44{037- (A'dQ*
OWNER MAILING ADDRESS: 9O ntc(2
kph, jO o3
.r
OWNER PROPERTY ADDRESS: t1
Ahl ii11 (
OWNER TELEPHONE NUMBER: IJ `•C -1
TAX MAP NO. : Sec ' 11 6 Block Di Lot 11 . 00
CROSS STREET: ouLQ
TYPE- OF SYSTEM: Septic Tank New )K Existing
Cesspool New Existing
Residential y Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
dpa
Signature of A.plican
RECEIVED BY: j
Town erk's Office
DATE: ��
I
• . Well
a el ,
c f ,1 9 x, The locations of wells and cesspools
0 O' shown hereon are from field observations 7e51 born
°e\\ �� c P and or from data obtained from others. o, 9
Qy3 740,056,(
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el' i
\c. Cto\ , 4,1 /7'
/ SURVEY OF
, s..\7;,,„\ o �e�- 1a \ LOTS 216 thru 221 incl.
,gb�` °cc < MAP OF GOOSE BAY ESTA TES
ico
Q9 / FILED NOV. 13,1934 MAP NO. 1176
\4. z/ ted= ' ,- ) AT SOUTHOLD
°r 9:1"/ k ;�' TOWN OF SOUTHOLD
h o y1v' ; i�� / N
tic, k 2�.3 , rn
iti 6 5 .� SUFFOLfC COUNTY, NY.
/
1.- �0 2 ? • '/ — — —
Q �V�, �, 39' z b 5 h y 2 1000 77 01 17 8& 18
j f - "� Scale: 1" = 30'
ick . f/�e9 J Q / ♦0
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P e r
�; � ' �55' P Mar. 31, 1993
5
p. d I p1� k"6 4-3.5
�y it,,,-",, �� r Feb. 3, 1994 (foundation)
f
�\ SRR til° ! i June 7, 1994 (final)
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,\ k AREA = 13,826 Sq.ft '
a L '„ cP ,o� ��
Sive.
J /50 -
S No.496, '�
The water supply and sewage disposal t �'��OF N
Prepared in accordance with the minimum systems for this residence will conform SUFFOLK FOR APPROVAL OFCONSTRUCTIONHEALTHONLYERVICES //
standards for title surveys as established to the standards of The Suffolk County N.Y.S. LIC. NO. 49618
by the L.I.A.L.S and approved and adopted Department of Health Services. _ 0 / oY
for such use by The New York Slate Land DATE HS. REF. NO. ,_.3 'ECONIC - EYORS, P.C.
Title Association. (5161 765 - 5020
U P. 0. BOX 909
(Q CP t well %cc f%ops 8��9�93 ELEVATIONS ARE REFERENCED MAIN ROAD
P t well /o,G t,ons S 8� TO AN ASSUMED DATUM. APPROVED
C
t / 93 SOUTHOLD, N.Y. 1197/
C.P. ' ,v // /oG�T/Dn_s
93-161