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JUDITH T. TERRY Z ` Town Hall, 53095 Main Road
TOWN CLERK v P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �' ��, Fax (516) 765-1823
',y®1 + �1,� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
^Neration Permit No. 2^vYY-'DDCSI J II1.1W : iwvo IIxcitaciIIIO
rCC d. in nn _
iu.uu . tpLII. <.C'S1.JVV1 A
New X Existing
Name Of Owner BYSHEIM; KNUTE
Mailing Address 1 50 HIAWATHA DRIVE -
Mailing Address 2
City St Zip BRIGHTWATERS NY 11718-0000
Property Address 1 BAILIE BEACH ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 99.00 block 3 lot 15.001
Cross Street EAST SIDE AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 2/22/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 90�FFo�
Town of Southold �� ; CQ ' Application No.o�(j 5
G
Judith T. Terry, Town Clerk a S J. �s '•
^' $10.00 - Residential I
Town Hall, 53095 Main Road at
v
P. O. Box 1179 ' ._ t ,1 `
�.- F � � $25.00 - Non-Residential
Southold, New York 11971
Telephone •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /6 , a d -
DATE 77)---,fi3
OWNER
NAME: / (f�C ZY,./-7q //1)'
OWNER MAILING ADDRESS: �o /4 W47;41/4 Pier �-
dX(6Tw47 7 J icy, /( 7,
OWNER PROPERTY ADDRESS: 6/gawk- get 44i42
/h/2-�7% ck_ /J 7 /7S
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 6 0 Block 3 Lot /5 00 /
CROSS STREET: £4f7 `f/Pe- /11./8,,J0
TYPE OF:;SYSTEM:---Septic Tank ' - - --New Existing
Cesspool I New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: Ak-Gtl Ktie/tffi
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.)
QS6( rG-2/
6t_ti jtr.
Signature f Applicant
RECEIVED: BY,:: — — - - - — __
Town Clerk's Office
DATE: - - - -
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? PROP 1-- Eprf� r4NK
"t. n WELL �1 1$•�j q�
INSTALL HAY 6At.ES OR a [\r Ig 6A7n, ����la,'8•6 CN�/�
1407 / 0, ..1\..„..„.„...... ....SILT FENCE PRIOR TO + per hi
ANY CONSTRUCTION a '''•A,,„
• • • ? 21•I ghWaY record
DWELLING C/fr�I \ -FOP LOG HousE 011'14: o'-' 0432loo'• �+..� \�FF_EL l6� aZo o, ‘9.1.'
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LD _ D I 2. '9\S66p \ ENCROACHES 0.1'
1. ��
,/,_ -_ �`� /� i/Acres _•'• DWEWNG now or formerly
(� • _ Robert D.Stearns et al.
1
� -5, LN��ST0 -il`\ O ,WELL IN
BASEMENT -
Or--
VS? O(O 3v 22 50"w \� LA►IOIVAfCD L!MIT OF '
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District
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TEST HOLE
DA•RpKpp-BR 0.0'
F-1411-Ip Ca12ADE F.F.=1�•o BR`CLAYEY "2.2
5'
LOAM 2 2'
+EL=1¢.y EL 1,4- EL-f4.5 BROWN
-� - + CLAYEY
SAND II 0'
BROWN
I,E92.3— 'LE•-12.5 MEDIUM
I.E.=11,5 +1•E...11.53 TO COARSE
15a h.F. 010E SAND
v./ALL A2 EA goo (a,1
GIEPtIG TANK .
0'
Ge.OP®ol,
NOTE
ELEVATIONS SHOWN HEREON ARE (c)`/P-( 1 P001 ‘ Y�fEM)
REFERENCED TO N.G.V.D.(M.S.L 1929) EG�1oh1- ,JE-vVA(a& *pl�P&'94L ‘ Y 'TE'-
SURVEY FOR
KNUTE BYSHEIM
AT MATTITUCK DATE JAN. 14, 1993
TOWN OF SOUTHOLD - SCALE: I" = 100'
SUFFOLK COUNTY, NEW YORK NO. 93-020
*UNAUTHORIZED ALTERATION OR ADDITION TO THIS
• SURVEY IS A VIOLATION OF SECTION 7209 OF THE '9 -
NEW YORK STATE EDUCATION LAW
\� *COPIES OF THIS SURVEY NOT BEARING THE LAND :•'' NEi '�
SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL ~
NOT BE CONSIDERED TO BE A VALID TRUE COPY '
*GUARANTEES INDICATED HEREON SMALL RUN ONLY TO ;` �Q �'r��`W. fl'')'''P''` `E
- THE PERSON FOR WHOM THE SURVEY IS PREPARED �C
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- CO ` �1'� C1i r/ '.Y';
* NEAREST WATER BAIN_MI.± *SOURCE OF WATER• PRIVATE_PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED ` * '4\-?,tr.'
a ?,', •
i7
* SUFF CO. TAX MAP DIST 1000 SECTION 099 BLACK_.QL.LOT 15.1 HEREON,AND TO THE ASSIGNEES OF THE LENDING r .' •+
INSTITUTION GUARANTEES ARE NOT TRANSFERABLE 1'�� ,ti
*THERE ARE MO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY t i
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT li 1� -`"
OTHER THAN THOSE SHOWN HEREON. :a ,, rr
OW
* THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE *D'I S ANCES SHOWN HEREON FROM PROPERTY UNES ,, , .?
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES ARE FOR A SPECIFIC
OF HEALTH SERVICES. PURPOSE AND ARE NOT TO BE USED TO ESTABLISH
APPLICANT+ PROPERTY LINES OR FOR THE ERECTION OF FENCES - s`DLANDS •' .
ADDRESS
TEL. YOUNG 8YOUNGR " EAVENUE
OR E
HNW
NOTE: ■=MONUMENT 0=4"x 4" POST 1= STAKE ALDEN W.YOUNG,PROFESSIONAL ENGINEER
RE; LOT NUMBERS,EAST SIDE AVENUE & NORTH LAGOON LANE
ARE SHOWN ON SUBDIVISION MAP OF"OLD MILL HAVEN CO."FILED AND LAND SURVEYOR N.Y.S.LICENSE NO.12845
IN THE SUFF.CO.CLERKS OFFICEONOCT..2,I925AS FILE NO.799 HOWARD W.YOUNG, LAND SURVEYOR
*TME LOCATION OF WELL(W),SEPTIC TANK(ST)&CESSPOOLS(Cr)SHOWN HEREON N.Y.S.LICENSE NO.45893
ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS
BRANDIS & SONS INC. 1046 • • -