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HomeMy WebLinkAboutColavito JUDITH T. TERRY : Town Hall, 53095 Main Road TOWN CLERK : P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER _ i�• Fax (516) 765-1823 � otTelephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1734-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner COLAVITO, MICHAEL & JOAN Mailing Address 1 198 DERBY STREET Mailing Address 2 City St Zip EAST WILLISTON NY 11596-0000 Property Address 1 MAIN BAYV I EW ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-248-4036 Tax Map No. section 78.00 block 4 lot 44.002 Cross Street COREY CREEK LANE Date Of Last Pump Out 0/00/00 Issue Date: 8/09/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) a OE ICEr OF THE TOWN CLERK 'c3VFFD (,p Town of Southold r 0�0 L'0�' Application No. /73 Judith T. Terry, Town Clerk � $10.00 - Residential (� Town Hall, 53095 Main Road P. O. Box 1179 v' '#t-, i'rt ;*. ; $25.00 - Non-Residential Southold, New York 11971 *-1 Telephone Telephone (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT AUG 091991 APPLICATION for ��;�� ►, i ��^ice OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE oi.,7 )9?/ (' OWNER NAME: 1 l 4�n I C c°[ 1. E % 1 LJ WI b L A\l 1 ID ' • OWNER MAILING ADDRESS: Nielz6`I 1 [E eF l d Cit ii1LsmuI N 1I, Gov `]/p OWNER PROPERTY ADDRESS: cJ f V (ems lm l.,oe< OWNER TELEPHONE NUMBER: Z-[o '-21L0 cx c, Wos I TAX MAP NO. : Section 1-8 Block Lot '1. 2-- CROSS STREET: MiA41U glgy Oft( ) TYPE OF SYSTEM: Septic Tank I/ New Existing Cesspool New _ Existing Residential -6// Non-Residential DATE OF PREVIOUS PUMP-OUT: LjI) ,ye lqe-0 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.) CJO1a - Wim - dm? 4 sRokttt8 41460_ , , -hArvx wo./J A. cq-,u_f =ture of Applicant RECEIVED BY: Town Clerk's Office DATE: • • V 13 n 1 P1 G KOLYE-t ' . i n - 1 0 , 4..k N.516 OW In :.. - 667.59 �t t�t,1 517 }• ••.0-„p.•e li`i"t Cit/r �, f t 4 I Z11 IS2' r f____/- 032. �P� ,��— 4f�R° �no v tah+• { >�esho% 't' rk:- \, /07 i uV.lboW11 `r .% IP 7 4.,y cC 1 �C !�sy ' X1.1 'tea' / ! \� ' -. _ � ,� TT k92:n4 �' '''okipf�A AM"'�OA --``-- -- -' l 5.46•is,To n W. 1 1 1 MO LL k \ ° s/. �•13�sn l��V. - '301.41' a I�ARtI ' . jc o�' gl A!C[HAa •ldS 9 %00'r,$) a - L. ItA LU r ' cc. 2 roluktqvi It f P = /� r I e S • Pkc< -fh 1- 1 a // Vac , ¢spy, P /MP O1 .'R0P 'QTY O SLALL- .- . DQ'= ;11 SURV6•yE•A r-0R I t -Q= rgotsmik NT EST //OZ...i.— - l ILUL 1 `iPLAN b Aiz A = L.93} AL R�S o T'k.. k•JF: 1 ToTiL AQL.I\= 3. 13b �t.R�S'�� Y`, 7.V.,i ooAN ( oLi\vi -ra . ._I, $$ed!J / MAUINOLQm MUTATION Ot MMpN `/ ;�..I �42Y' ® ti AROIT6 O o WI- [TU Tmn+ cSULVIT iTwww1.°2OS "�n z ���)tTvATE `/4�T 11 I T T 1 ARANT4[• [ ,,w„uw. ./ \/ T T - `I L •a SUgV -YLV 1 AU4U T 23. 1971 COMA OI M3 SHIM MAP NOT IMMO Yy Qo DSRILI( VqN TuyL , (�.L• ;uSSAmY Iu1L1' r.c`ra6ew NI E% yank - , - may.. /) / CiIAWORS I OICA110 iM1P:ON WALL O.i •' •1 yT/Y /,�%/M ✓yy.C(ti/• ON11 TO TN!rL3OA FM W:VM INS SI=R► IS TUFA=w�,C - LIU6uSEA LANA SURVbyfl ' ..SCUM"""OO•- 1.14NA 47 TRI! C:Difin r-D SOLO AO,NA MID MEM C:IOUI o Lj, M.::Or1,Ab likb;NPORT. 140,V YORK TO TNT ASS.S'ISTS Of IN:LJSIA'O WTI. ' M•ON.GUMANTITS AL1 I.OT T•AN4Ts:A.I TO ALT OONAL It6CJ T ,IJNS 01 SUISICANNT - --rIT'CAI . . ....I"I:t'= /-I g .r —_r'I 1 t`..:..OWHISS . • .. •.- r l 1•.1s..J•G�• ." _ .-� ...,='..1�..'k`w .w✓•'•-t ,••1 r- �.. _ _. ..._�� -t ti _--.•-. _• ` •TOWN`OF SOUTHOLD 5838 Ticket No. 1 r : • �:. SCAVENGER WASTE REPORT •' .-. o p .' Fee: $.02 per gallon ' �!-„,,,,* Fee $'..1-/G) paid . • .' . Name of Hauler` Date .-1(-9o. . paid - / Southold Town Clerk • • Permit Number - Truck Capacity . . . o ©.V.c+/. . . . • •.• Gallons Liquid Waste Date Pumped ` Residential, Commercial • - Restaurant - 0 SPLIT LOAD @, • ,Gallons ' - • �- • . Location: ” -Nameof 1 , . . 2VL1.L) - l_Q) Owner. . . �� s��.vd, i • Street . .'401 L I-2k • Hamlet. .(....71—.40. l Telephone.Num.= Tax Map r p. . 3. .D Cross Street e,..4Olma )ZO Diagram (locating building .and c- •ool: -Give north arrow and feet of distance, ' approximately.) • _ vv .. VOGt. - ).1 . , ..,, ,. , . a .. ,.. , , . , . .. . , . , . ,,, . , . . , .. , . ._ . . I hereby'certify that the above originated within the Town of Southold/Town of Shelter • Island at-the above location(s),' and to the best of my knowledge, contains no chemicals, ' =..'' hazardous, or-toxic wastes. False 'statements made herein are punishable as a mis- .' w demeanor pursuant to Section 21 -45 of the Pen.l Law'of the State of New York, and • :"-, • may,result in my arrest and tt i p.©,.men ,if t eki.i .le I am-driving. Name of Driver . • . . . . r a:A.• 1. i Signature of Driver • • { Received by. . . . . ify .• ' Date [1. `c. . . Time . . . / • .(1) eatment Plant