HomeMy WebLinkAboutBaker (2) JUDITH T. TERRY { ' Town Hall, 53095 Main Road
TOWN CLERKP.O. Box 1179
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REGISTRAR OF VITAL STATISTICS XWI _t� Southold, New York 11971
MARRIAGE OFFICER Cid O • Fax (516) 765-1823
® ���i!' 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. 1779-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner BAKER, JONATHAN AND CHRISTINE
Mailing Address 1 4248 GRAND AVENUE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 4248, GRAND AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-3887
Tax Map No. section 107.00 block 2 lot 2.004
Cross Street GRETON COURT
Date Of Last Pump Out 0/00/00
Issue Date: 10/08/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK 8c.SFO(,r�-
Town of Southold r Q 31% Application No. /777
'7 Edith T. Terry, Town Clerk
Town Hall, 53095 Main Road �;^+ t y� 'H*
$10.00 - Residential
u
P. O. Box 1179 n •� ", ► ; $25.00 - Non-Residential
Southold, New York 11971 O'7lo~ . .,; .> O�•�`�
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE /0- 3- 9)
'OWNER NAME: JDAJATIi19-73 CHZ/.5-DA-16- kia lLE7Z •
•
OWNER MAILING ADDRESS: 1440.6 (MJD AJC.XILIC
M 11 TUCK , NV IfQS-1-
OWNER PROPERTY ADDRESS: - .:II14 /9-S ikI )VC
OWNER TELEPHONE NUMBER: c /8 -3887 vel o?/E- 53,58
TAX MAP NO. : Section 1 0i Block Lot cQ • 7
CROSS STREET: 6 t fuff e-91-ST O 651ETDAJ CeJ ?JT
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New K Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: JU/,
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.)
/ , i 7 /,'
Signature of Applic.
RECEIVED BY:
Town Clerk's Office
DATE:
•
Title No T/284 - 3006
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' WEPT. /8, /99/
I SEPT /5, 1990
I SEPT /0, /99 0
I FEB 19, 1988
FEB 25, 1987
i SURVEY FOR Nov 28, 1986 l2 , 1985
MAR
I
JONATHAN BAKER 8 CHR/ST/NE BAKER MAR
Rs;AUG /964
/984
AT MATT/TUCK DATE JULY 27, /984
TOWN OF SOUTHOLD SCALE / " = 100 '
SUFFOLK COUNTY, NEW YORK
NO 84 - 742
N UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANTEED TO
suRVEr IS A VIOLATION OF SECTION 7209 OF THE THE TITLE GUARANTEE CO.
NEW YORK STATE EDUCATION LAW
N COPIES OF THIS SURVEY NOT BEARING THE LAND
SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL SSE OF �F{�r
NOT BE CONSIDERED TO BE A VALID TRUE COPY
XGUARANTEES INDICATED HEREON SHALL RUN ONLY TO S `O
THE PERSON FOR WHOM THE SURVEY 15 PREPARED
-HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT AND ON HIS BEHALF TO THE TITLE COLS PR , GOVERN- ��3D W. �O 9�
MI -` *SOURCE OF WATER PRIVATEPUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED
N NEAREST WATER DIS P 4 HEREON, AND TO THE ASSIGNEES OF THE LENDING 0 �,,,;
N SUFF CO TAX MAP ELLING0 SECTION 007 FEET OF 02_ LOT _ INSTITUTION GUARANTEES ARE NOT TRANSFER ABI E ;,
MTHERg ARE NO DWELLIMIbf WITHIN 100 THIS PROPERTY TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT } �,,,'_�.�� �y
OTHER THAN THOSE SHOWN HEREON OWNERS I '� ,
If THE WATER SUPPLYIAND SEWA9E DISPOSAL SYSTEM FOR THIS RESIDENCE *DISTANCES SHOWN HEREON FROM PROPERTY LINES ��,r y l
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES ARE FOR A SPECIFIC , 1,47,.; 1- • '
OF HEALTH SERVICES PURPOSE AND ARE NOT TO BE USED TO ESTABLISH
APPLICANT I PROPERTY LINES OR FOR THE ERECTION OF FENCES !�, *0 4589
ADDRESSf° ( oltir ANDER AVENUE
TEL •{ YOUNG a YOUNG RIVERNEAO, NEW YORK
iki.NOTE ' AREA = 4. 09 t ACRES O= STAKE ■ =MONUMENT �� �, 'f , ALDEN W YOUNG,PROFESSIONAL ENGINEERr�) ,;
RE' LOT NO 4 , "M/NOR SUBDIVISION FOR LYNN SAN Itis, .. :a , AND LAND SURVEYOR N YS LICENSE NO 12845
ANDRES ",;�.'��}t� HOWARD W YOUNG, LAND SURVEYOR f
I `--' N Y S LICENSE NO 45893
*THE LOCATION OF L(W),SEPTIC TANK(ST)a Cl.SSPOOLS(CP)SHOWN HfREDN _` �,�.e
I ARE FROM FIELD Olf3ER'ATIONS ANO OR DATA OPTAIWEO FROM OTHERS
BRANDIS & SONS INC. 1046 _
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