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Home My WebLink AboutBlaskovic ,64 JUDITH T. TERRY Town Hall, 53095 Main Road TOWN CLERK T ; P.O. Box 1179 • REGISTRAR OF VITAL STATISTICS - � Southold, New York 11971 MARRIAGE OFFICER ��® `de, " : ,. Fax (516) 765-1823 1a .�` 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. 3079-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner BLASKOVIC, NEVIO Mailing Address 1 P. O.BOX 1431 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 580 WILLOW POINT ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-1681 Tax Map No. section 56.00 block 5 lot 29.000 Cross Street BAY HOME ROAD Date Of Last Pump Out 0/00/00 Issue Date: 8/05/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) I/•- - OFFICE,OF THE TOWN CLERKc31 F ' Town of Southold � OCA- Town Application No. 30 7? Judith T. Terry, Town Clerk ��' $10.00 - Residential Town Hall, 53095 Main Road tt P. 0. Box 1179 ` s $25.00 - Non-Residential Southold, New York 11971 Telephone 4410/ 114 �� '�• (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE OWNER NAME: /4// lJ AXSV4) ///C OWNER MAILING ADDRESS: ,P0P0 Ae T-04 7 J� dam' / /3/ S©v 7/021) //9'7/ OWNER PROPERTY -ADDRESS: JVO j/;:i Gt a/f-gr ,4 2 .So V/WO . // 97/ OWNER TELEPHONE NUMBER: 7bC--- /6 kr TAX MAP NO. : Section j`-c Block .05- Lot 27 CROSS STREET: 7{ "/ Apof?'I� TYPE OF SYSTEM: -Septic Tank New Existing Cesspool 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.) /7,Z "% Signature of Applicant RECEIVED BY:4 Town Yerk'uffice DATE: ..z-A - • 1 , ROAD L= 167.94' 3 • E.� Ft, \7 59 WILLOW r \i \-o Q �`°� \CO'. 66 �t`o�c - �L JG NJUJG �� 1 5 pO N.87°15 t0 E. R=348.79 I �/� p�'o`�= / / A.,, L--13'4.7 3 70.0 0 0\5\/6 cl c3 ,f ,' G0, • IA 68 \6• \ �� F s (24i ' i 23'16 '' CIO ,�• " �. ,� " \CIO 4 s--1` ii g zy ', • se l 3, • G / p 4) / Or �\v,. 60 e `�� L'39.2�, 2a, O� `�'� \ �'' �� • CO - �O \ O� y� co �O 9O I SURVEY -FOR JACK RICHARDS • OF LOT 26 "WILLOW POINT " •ARSHIAMON1IAQUE NOTE: - - TOWN OF SOUTHOLD Ii= MONUMENT • SUFF. CO., N. Y. SUBDIVISION MAP FILED IN THE OFFICE OF THE r CLERK OF SUFFOLK COUNTY ON JUNE 16,1966 AS SCALE : 1": 601 „= 60, MAP NO. 4652. DEC. 14, 1966 04 ' y_ / ti!YJa :.� • PROFE QN L I NVINEER AND LAND SUR YOF;'N.Y.S. LIC.N0.12845 —'”',-- _ RIVERHEAD, N ti. gig.