HomeMy WebLinkAboutCaprise JUDITH T. TERRY � #� Town Hall, 53095 Main Road
TOWN CLERK ♦ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
® .�� Telephone (516) 765-1801
41 IP"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1645-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CAPRISE, MICHAEL AND CYNTHIA
Mailing Address 1 6565 BRIDGE LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 6565 BRIDGE LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7538
Tax Map No. section 84.00 block 1 lot 6.009
Cross Street OREGON ROAD & ROUTE 48
Date Of Last Pump Out 0/00/00
Issue Date: 3/14/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
JUDITH T. TERRY �Y r`^, "'' Town Hall, 53095 Main Road
TOWN CLERK • P.O. Box 1179
`. SSS'IffD) !I,
REGISTRAR OF VITAL STATISTICS _- � .�� Southold, New York 11971
MARRIAGE OFFICER VOA, C _ '- ��' Fax (516) 765-1823
= 44 071/'r Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1645-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CAPTISE, MICHAEL AND CYNTHIA
Mailing Address 1 6565 BRIDGE LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 6565 BRIDGE LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7538
Tax Map No. section 84.00 block 1 lot 6.009
Cross Street OREGON ROAD & ROUTE 48
Date Of Last Pump Out 0/00/00
Issue Date: 3/14/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
a d n
/
OFF'ICgE-:SOF THE TOWN CLERK \\VFO
Town of Southold
PP
%S C Application No./6 Vs-
Judith
�= D
T. Terry, Town Clerk
. $10.00 - Residential `N
Town Hall, 53095 Main Road '�
p. O. Box 1179 u' -:t $25.00 - Non-Residential
Southold, New York 11971 ��,��`
Telephone �� ��
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLI CAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: /�� //�� /`�/G1? z�zi� �/ %jsC�
OWNER MAILING ADDRESS: zs' /5 "9-e.;(74' 1--9
OWNER iROPcRTY ADDRESS: ,57,9/7.7e —
e —
-
OWNER TELEPHONE NUMBER: 73 25
TAX MAP NO. : Section 6F-172Block / Lot ‘- y
CROSS STREET: /-1~&� /,,�7,f�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP=/OUT 'G7-/
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.)
Signa i. -- of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
;y ' ,
`-i Initials Date
� �(te� p l Prepared By
Approved By
1' 2 n 3 4
.-k_ — / 97 —
-. - - - ‘--1------Z-746-/<//ki
_ / 3,5.
I Ip/1 2
!
( I 3
. P'I t1 4
(1!1 (� 5
rt ff I! . 6
tJ y I7
8
11...)1
V.) 1
. r..1� j 9
i - ! 10
,
1:1 -- 0/�ii/ ) i 11
. 'mss �G� (1 12
i (--:'-',/,
� f,�„ --4:40), . .y uy��d�d Ajr�/,1 13
I 0 t-i f�� r J/ ., It/i7.7 �n.`/t/1 14
,� 1...
t. I 1
ji J r.,, P)Pt .'� J 15
I a� r` e r., 16
.17
1 "-i' za (1-1�% 1 11 � 7) 19
II { AN � 1 20
- (k _.,____, -__- _ r �l
I
21'
. , 1 . 22
\� ..I
' 23
•
I� 0 .I i 24
H25
1 �)/ l !'1 27
, 1 '
7
( t- - @ I 28
]
1.1 1 1 T '
Ili
II 30
29
��- -- --- iii
' --- 32
31
33
34
, \\*\'
35
-- - \\ 36
37
38
. 39
, il v
40