HomeMy WebLinkAboutConstantini : = ;i Vii'
® `r '' Town Hall, 53095 Main Road
_� I.
P.O. Box 1179
�•, Southold, New York 11971
JUDITH T.TERRY
r --��,ii,ir0!. FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1560-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CONSTANTINI, ROBERT M.
Mailing Address 1 5700 PECONIC BAY BOULEVARD
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 5700 PECONIC BAY BOULEVARD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9738
Tax Map No. section 128.00 block 1 lot 4.000
Cross Street BIRCH DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 10/23/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
_1
OFFICES OF'THE TOWN CLERK 'c§WFO '
' � Town of Southold
o QQG' Application No. `�
Judith T. Terry, Town Clerk ' " f�f w k *
Town Hall, 53095 Main Road ~ _=€ }4 =4 $10.00 - Residential L✓
P. O. Box 1179 n :t.:` ''� ?4 ' i
t ,,,,„ $25.00 - Non-Residential
Southold, New York 11971 14"O '® 0�.,A.�`
Telephone ®j %N
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /O
DATE ,®° l2/7°
OWNER NAME: Med % 4 .
OWNER MAILING ADDRESS: ,j2'o / --0/41--c-- 6Z /
N'V //f "
OWNER PROPERTY ADDRESS: 'ilYlZe-
OWNER TELEPHONE NUMBER: 027,E 973cf
TAX MAP NO. : Section /al,-eyo Block 0/. OO Lot ®®Y DOCS -
CROSS STREET:
TYPE OF SYSTEM: Septic Tank ! New Existing
• Cesspool ( New Existing Y
Residential >< Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,9 9�
l
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.)
/4:=4,1 A - - -
`Signature of Applicant
RECEIVED BY: _
-Town Clerk's Office
DATE:
iPO.BE
SURVEYED FOR:- �/T M 4E4 k/�N, CD ,Q��iC.// ti
LOCATED AT MATT/T /c/ , TOWN OF 2../77-/C:)G.C:, , SUFFOLK COUNTY N.Y. .)
LOTe.
MAP OF Z:DESC,O / b/ 77)' `
, CO. CLK. NO. FILED I!-'
1 SCALE 1" ., (..7-.42:i ' c__�
-- _ --�
SUFFOLK CO. TAX MAP DATA:- - /
DIST. /On', , SEC. /26)/26)-0')G -dir / I '
BLK. /f)' N1'�' , Z
O/.OQ LOT O
• 'OFFSETS FROM STRUCTURES '/'/ / - �'
TO RELATIVE BOUNDRY LINES, ► 7�d� /' / 16.--,, C�
ON SURVEY, ARE FOR A C2 73
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SPECIFIC ONLY, AND �� 7 .D ,M ��
SPECIFIC USE
SHOULD NOT BE USED FOR � � \>" .„ .��t Q ,-
CONSTRUCTION OF FENCES " '1 " e��a \ - •
OR OTHER STRUCTURES. *l !, m
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1 j ` /7 •Q/ SURVEYED 444_,--5.3/ 1 BY
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WILLIAM R. SIMMONS JR.
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s FIFJAMESPORT, L. I., N. Y. 11947
' L_ NO. ��9690 PAGE 2
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