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OFFICE OF THE TOWN CLERKcOFU
Town of Southold � U(C(V
Judith T. Terry, Town Clerk ' *).
Town Hall, 53095 Main Road
C.-
P.
P. O. Box 1179 �
Southold, New York 11971 p •;'
Telephonei
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
'SEPTIC TANK or CESSPOOL
Operation Permit No. 242 Residential x
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Evelyn E. Ba ng
OWNER MAILING ADDRESS: P.O. Box 445
Greenport, New York 11944
OWNER PROPERTY ADDRESS: 730 Westwood Lane
Greenport, New York
OWNER TELEPHONE NUMBER: 516-477-2253
TAX MAP NO. : Section 33 Block 2 Lot 16
CROSS STREET: Inlet Pond
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Never previously pumped.
Judith T. Terry,`
Southold Town Cle -k
DATE: March 31 , 1987
(TOWN, SEAL)
OFFICE OF THE TOWN CLERK ir� b���'
Town of Southold w C' Application No. `7 2--
,x �Q '`
Judith T. Terry, Town Clerk . 7".4 .
Town Hall, 53095 Main Road ;� ;7 :: } Residential
P. O. Box 1179 cn `�� � i ; Non-Residential
Southold, New York 11971 O ® '.. '
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 02961d—
Fee $ /6
DATE "--)1/%-41'-Ge` v 7 / ci27
OWNER NAME:
OWNER MAILING ADDRESS: /'U. deo," 4' 'J
2/ Y //IS' V
OWNER PROPERTY ADDRESS: 73 6 4/_,Z4oq" L-
OWNER TELEPHONE NUMBER: y" 7 — Z. Z .i
/
TAX MAP NO. : Section Block ' Lot /
CROSS STREET: / f
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool i New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
Signature of Applicant
RECEIVED BY4
RECEITToowwn 2
erk's !`fice
DATE: filAR 2 6 ii67
'town Mark Southold
- � j SUFF.CO. HEALTH DEPT.APPROVAL I H.S. NO.
t
OWNER: - _
- EVELY SANG ,
J44,-74 - 38 T" Ave.
FLU5H1NG h1.``ir. 11.354 - . .
... -_ (Te..Zt2-3i9-8140 .
AREA: 34,91?- 4Cj.ft. - • ----- - -
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lr_ �9 -- � o, " s 1‘a O� • TO LINATHIS SURVEY CKLED r von R VIOLATION
I
I g e Oi • ,4 SECTION r^9 OF THE NEW YORK STAT[
I EDUCATION LAW.
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1 1 I �• _ ^ COPIES OF THIS SL:TTVEY MAP NOT BEARINF
r ! :•.rQT 3� THE LAND SURVEYOR'S WIND SIAL OR
EMBOSSED SEAL SHALL NOT CT CONSIDERED
--f-- /V CE Ga r{, \ TO BE A VALID TRUE COPY.
I L - ) :D H
GUARANTEES INDICAT :T.:CN SHALL RUN
ill ONLY TO THE.;'E-.SON FOP. Y.:;,M THP €L/RYE,
Di
IS PREPARED,AND ON KIS IO:::rIF 10 THE
I n TITLE COMPANY,GOVi.".NML.'i A: ALVGCV AND
- LENDING INSTITUTION LISTED H-R:Oit,AND
'- �" TO THE ASSIGNEES OF THE LET-OING INST6
I CERTIF. I TUTION.GUARANTEES ARE NOT TRANSfatAni
TITLE TO ADD.'ilONA1 11�YTITS1TlON5
owNas. STAMP
G t deg ed --:,c,--Hie
MAP O= LOT 8 . Gly:. o Ti+te IrtLsrarl
ce Compefiny SEAL I
°MAP OF r=ASTE :4'5140(2E5-SEcT,Z" and +0 +Ne 5o.5.1.hcld 5GNI i•r:35 sit,/km.
(5 &k. Coartt9 Mop NO. 42.6) s .t..1T-uetjed .duly l5 , :977.
AT . RODERICK VAN TUYL. P. C.
GzEENPOI2T /2 '/ S_ ,
TOWN OF -`JOUT-4°L , N -Y. LIG LAND SURVEYORS-GREEN T. •Y.