HomeMy WebLinkAboutCollins s
:r'
° i Town Hall, 53095 Main Road
1 co °0 P.O. Box 1179
��i,,® �G� Southold,New York 11971
JUDITH T.TERRY li- ei4: TELEPHONE
GOWN CLERK *' �a �'� (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3603-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner COLLINS, CAROL
Mailing Address 1 C/O GENDOT ASSOCIATES
Mailing Address 2 P. O. BOX 847
City St Zip WADING RIVER NY 11792-0000
Property Address 1 95 SELAH
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 106.00 block 9 lot 4.003
Cross Street COX NECK ROAD
Issue Date: 4/08/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
, .•..
OFFICE OF THE TOWN CLERK ` \\FFD
Town of Southold ®� • �QG Application No. 3 . 03
Judith T. Terry, Town Clerk � �} 3 :
Town Hall, 53095 Main Road 8 $10.00 - Residential
P. O. Box 1179 Cr' �, tri
_ �� $25.00 - Non-Residential
Southold, New York 11971 ® � � �1`
Telephone : I �,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. fiZk
Fee $ •
,-y
DATE l /0G/9'
OWNER NAME: 6,0„,...6 �C
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 1/0 6,e-e) Block (7 Lot "1/1 Qd3
CROSS STREET:
TxY_PE- OF 'SYSTEM:- Septic" Tank- - _ f - New V Existing
Cesspool L.�' New I Existing
Residential V Non-Residential
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.)
7//'
Signature of Applicant
RECEIVED
RECEIVED BY: .
kl R!n (814087s Office
DATE:" Sen1 tjlold Town Cr*,
fit �,Ti_.Tp• S'T,; ILL SUeP 1 VISI O1
• , .. 7 ty s i1?V.EYf •f'4telif:{'ALII.''Ff21EP8Ef2G, ,
- _,:FAO;11T E SUFE=ca,:cLet2_c�S_GF fcE,A5 MAP • .95 .
• . • ':2�O1 3u12-. 'E. .S To frt� SEA EVC�._..KIGVJ •
` '
• '- ;. s.-:,, .0•
,-
41
•
..0.P4:14:0 L --.__, ;
•
TV-, I, .
SIL./4 LANE
•
__�_` ^S�'I" �no 185.Q
` „� P PTIC
•
I,
vyoa. rF \ Q'
o . c
• \.�,, , i
.3
`fes;; -' . ' ,, I ��: =L • tri
- .,� %, . ' .,,�'til}tea - ,•
••
a=r. • • ff
7,-_.
' .';`'..i.';,1::;,.".'•;-.:'
y
•-•?...--, - •a - _•}•.. • � '. u .- r - r.. ' •
-
T't.kl 1. µ'? f; ;:. r:�., - •T�r` -.-•r5• •- .,• - ' • . ' - {•�• • • v'jam' • , =�"�', ,
I V•.'•l .q - L:..1r :.T. ....*%, • .^.• ' •t=•_r,;;..' - _t •M•f ..
�+ w..-:- :vim��_`."s,.!a 7.+F:•�•.�Y,;.r:,,..,,�1' r`_........_,. - ,..1.., k..... ,'i.w>. _r.... s di•-•, . s_,�..r.. ;-\C i-
— :v F.L.L ----E
f
MOTEL: -
1.[�QY NG .:.i2..E�- E'7 Y'/"� WE'TI MIL. lE'[ ,fI _, .- .,1'
}"'rr)PEIli'''f 5t-;%LVE'{r,r) P('.)/��_ t 4, ?AUL,UL. Fpie:.`k F:iir,.
.
t'1 EC 11,4 THE �xJiCC"F. .�-.' '``.ET21l ri,;i'!-li;, :; J' i-li Y . :i' 'fir',•.
%.;.:.11,.;To .; . if EF=1;...S a t-1E-AI,i 2,-.h t.EVC: .--,,i117 i',,,.,-
: I
DJ, r
1
,.ES.
r-
L
,
\ -- _____
��' �E L„,-, L-A!'-1E
1 yy�� C
[ \..." 4 a \
4 1
`F 4 , riff, f4 ,,--,
i
,Pr.-.)r, 5 r�u -
\ C'C:--)Peo W[7G10 ne:14
\--,..\I i. ,....L.,,j
i:F
c
iF I ) c\\
TO '✓J`i_L y ^ ! A. , re:_ . cr,
,.,
I --- y 159 + /-7.__-- _ 1 --- - - '
,1.72°
x 4 q .i. Ir,.-
1
0
~
E_°DYNE POST NR}32° '
e