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JUDITH T. TERRYTown Hall, 53095 Main Road
TOWN CLERK O yZ4t P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
y �� Fax (516) 765-1823
MARRIAGE OFFICER �_®` ®�' •
__7,�/®1 Jig �� .° 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. 2016-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner CAVANAGH, JOSEPH
Mailing Address 1 DAVID CICHANOWICZ -
Mailing Address 2 P. O. BOX 160
City St Zip PECONIC NY 01158-0000
Property Address 1 PRIVATE ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-734-7923
Tax Map No. section 77.00 block 3 lot 18.000
Cross Street BAYVIEW EXT.
Date Of Last Pump Out 0/00/00
Issue Date: 12/03/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
l.r
OFFICE OF THE TOWN CLERK �FFO(,��
Town of Southold0�® CQG', Application No.
Judith T. Terry, Town Clerk . ' 'Y
Town Hall, 53095 Main Road 4 $10.00 - Residential
P. O. Box 1179 cr3 _ z $25.00 - Non-Residential
Southold, New York 11971
Telephone _ 1 Nt
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
RECEIVED
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
DEC 03 1992
Southold Town Clerk
Operation Permit No. 18 I T
Fee $ •CO
DATE 12-J2 /92_-
OWNER NAME: L' A\!A N n ZO S EP4
OWNER MAILING ADDRESS: C C!-}ANO W ( CZ-1 SAV I (D
� u ILQo rod,ic,1 1i.y. 06
OWNER PROPERTY ADDRESS: Pi24 VATS IRoHD
oOT OL1J : '\l.
OWNER TELEPHONE NUMBER: �� - 4923
TAX MAP NO. : Section 5q.O D Block 3 Lot 18.00
CROSS STREET: 1CA\.{ 'U( eVr,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool '( New )‹.'• Existing
Residential Y. Non-Residential
DATE OF PREVIOUS PUMP-OUT:
LOCATION MAP: Must be attached hereto before permit maybe issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road,)
Signature o App d ca
ate
RECEIVED B : (Tli
wn Clerk's Sitifice -
DATE: / c:,? " 3
The locations of wells and cesspools shown hereon are from field Prepared 7n accordance with the minimum The water supply 8 sew oq disposal sys-
tems for this residence will conform to the
observations and or from data obtained from others. standards for title surveys os established standards of the Suffolk County Depart-
by the L.I.A.L.S. and approved and adopted ment of Health Services.
for such use by The New York Slate Land
Title Association. -
( VACANT 1
Well
SURVEY OF PROPERTY •
AT f14.s 30 WIDE RIGHT OF WAY recUEsT El fro.4 fe9
BAYVIEW
Z
TOWN OF SOUTHOLD W. _ s. 72°2s'3o"E. 140. 34 '
Q - w _ ISJ T HOLE - 1P.D
SUFFOLK COUNTY , N. Y. y o I • o
1000 0771`) - 03 - 18 01 o
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CD CD 0 N I 3/L Q
0 1 •
TEST } -- - -- -- 19 I r K?/ 3
SCALE I = 301 1 DATA a 4i 3,�• ¢ „ �r/
— IIII DARK BROWN LOAM woea� �• - 3
DEC. 310)1987 10- u. M ac«K[ 2s�r �rhse. y�/! !k f zo o
APRIL.25,.1988 IIII BROWN SANDY o Q' gar: under--••44 / / < _ F- a ? 2
DEC. 23,1991x (found. ) BROWNLOAMY
= o /�s o d' p y �_ v
Dec. 1992(final II
SAND a CD ti — — — 55.2ti _ __ O a` F- j .
Is • • ME13"14 AND o= . E1L 0 6.
p saecc
-COARSE SANflS 8' Z e` A 39
IN . I ♦•k. J6.0 Cq 0 ..
CER TIRED TO ; -_ -s�BROWN coIa 6 — —" 20.12 1• ` `" 173
• CON ' <<. --+'L GONG.
AMERICAN TITLE INSURANCE CO. WATER
A RNs,; .BROWN "I MON' I°3 N 72° 25' 30"W. I /� .140 24' g "ON. 3
DAVID CICHANOWICZ III
17' W f o
D 127 P`�
3
M N /0 / F ROBERT WESTERaEK8 - '
v
' a JOYCE WESTERBEKE--
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pF NEW y ( DWELLING )
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,� * SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES I
•
`9I .Y_ S. LIC. NO. 496 18 AREA '= 8 , 41.7 SQ. FT.°•E f� ;� FOR APPROVAL OF CONSTRUCTION ONLY
, l' `
fra: r Ltva nOnrs armErxED
A•RS a ENGINEERS , P C. 9150 12 TOaNassclvmDaruc
' _._.__ HS REF.•NO.
( 5 -`f . ; D-S � % 2O- - ,�
P.o. _ - NORTH BAYVIEW ROAD
1. MAIN ROAD APPROVED
SOUTHOLD,N.Y. 11971. prop. fisc 3-/a - 66 rewse.,,,-- & c 2/27/9) tevised. hse 3/4/9/
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