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HomeMy WebLinkAboutBoczek ,111•` (1,1 Town Hall, 53095 Main Road '_ " � '�� P.O. Box 1179 --_�®� Southold, New York 11971 JUDITH T.TERRY 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. 1471-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner BOCZEK, HENRY Mailing Address 1 1370 STROHSON ROAD Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 1370 STROHSON ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-7573 Tax Map No. section 103.00 block 10 lot 28.001 Cross Street BALDWIN LANE Date Of Last Pump Out 0/00/00 Issue Date: 5/30/90 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFI;E OF THE TOWN CLERK Town of Southold S�FFO"C' J / y � �� QG' Application No. / y''� Judith T. Terry, Town Clerk ter. '::::k4‘) $10.00 - Residential V 'Town Hall, 53095 Main Road ,< : P. O. Box 1 179 t17 # rF, �a'� ''� 3i � $25.00 - Non-Residential Southold, New York 11971 Telephone 0( `��� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ '® DATE nit V V /990 OWNER NAME: ' /o • OWNER MAILING ADDRESS: 13 '10 & d R2 oh o iq rep OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: 73L - '7313 TAX MAP NO. : Section /®3 Block /0 Lot aPr / CROSS STREET: i F? L-D W I M itagoiri ho6 TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing IV Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: -�-Y��'ezr• �r ¢a`� � /9 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 BY: CO/0(1k,-- w"n lerk's Office DATE: v /'t 9-6) - .,'‘-..:'74:504,11.34-- hi •''Mar' Wellee-' . �.,. ; •ti. "`re1. M. 5eawre�n • 1 3 ;' 31 ., • 0. • i � ►l L� fin' 5. 84.54'20"a. — /65.50 1 v ' r. ;A • - T �� I♦ �alfS on line 38.-^R- 6F _ 'x P• —1 -' -g .it - I �, main `4 wU. • ;61 �*i = f/: cl. r •• • : ;tom: ;;"F , =� • fr. iFa. • i6r. ii i h3 •S. - .r.....-- ,..., r .q, . \ 1 2 ,. •- ftell Z. 1 ri'b�-=',":/,' A ~a `�':r SY=ra ' �'° .Pfc.! , &TeJ 4' ,z iyH�• '• \•+ `�! ' \rO _ Any J.4�'L i v'y'W)• 3die"`"�- , L : 17 .50 • p� � , Ptaie —is-1- —. -., ----, --...-. ...,,...,.y:-..z,., 3: - ,-ri J^ '��' -r,', • ;,, .r --�-. ,LA.-f'H�,.2 lu`'�`.� ' .rt ;�'k • • • • ; ' " ?; ^x » f •- 'n Q © f v 'i- • 27 emY :::"..1".,:' . �' a-1 -- L`: .. - 2VeY,t3 Fa -�c 44 .. ) •• yj.-■/]s`)Yj .,.:. - _ .,is, k• 7...1%.-,:,.. .t.,‘f. •'tZi ::„.,,,,-,,'• ;S : ; i',a i.Prs.�i.:61,1' At' ' :i.. ' j.. .- ^ ` r }-.4 •C , D IV k r -"SG t, y ,L „4 :t :;4,,,• Y r•' - -- - ,. t.Y" - '� • moi - ^f zi,t r°, ,,---7-:., JNAUTHORI2ED ALTERATION OR'ADDITION ' T` •;y u�y 3.4.... • • TO•THIS,SUCVEY IS A.VIOLATION OF y ' r aL` Y; Y , •. • .SECTION 7:09 CF THE NEW YORK STATE f'ti f �CL,j ,, F°' •t47e"ri ` 'r - 4- . ��-a A ,A yt'':.%,...,..,-^^- (DUCATION LAW -VI' . :ttom „_ 1/1 r rice Co-.cmai fo•-Fke Akre k �?.,. 1} ;S•. .. 1 I S OF MIS SURVEY 1/AP NOT BEARING �, }•r` - YL E•.,r�y',MN.•sy4�„,• <,,. t';, , _ - ,.. LA,D S...v,l,•t;'S IN::.D SEAL OR Midland 77, r3!. A%Q •Gi1TGl'i acetic. • } ':-••� 'ti ��i"''w• .%- . 1 :._b' __ •1'60:5,-D SCA:LI,AO.NCT CE CONSIDERED a =t�P 4.:A'`.e.S4,,.•1,.'' ,.`{`4, 'f..X. ." -%:�.c ' J• -+' -,i0 BE A VS A T UE.COPY.' CI3 5u II�.Q !Nov, e% I .- • '••1 •t *r �5 aTj. ,•.t.t... �,} 3 ' j"GUARANTE.S DKCI'Ar.D 1:RE ‘9.:-.3f4:-.4,..,14,,31,4,..,.....i.,.....,..� C ON SHALL RUN :•� . a t ONLY TO Tr;:r:.;;:F,.c w r � V AN Tc���` � n ^ /� •� -.3. 'fi,�, : r,iCM THE SURVEY ooeteicx }PCS ' •` -0 ,y.�} '.3' )-•(_PPI-j7:44.-':-$'• -**y4 vj }+ cliiiiR QFC ' •t5 PR JAELU. A•:. 0'.AS V.HALF,TO THE / 7 k:. ++ 1 ;iYr` �` ,:?f 1 e" �'-tt it �I• TITLE'CCMTA':T,',...rial.:MENTAL AGENCY AND V s. :ty ;s 1....,,,z_ r� ..,,,•;,::::i!-..,-,:.,..! �`'i .LENDING L•S:', 'ON L LLD e1.RCON.AND - _•��_ +r�_ 't- ,>}�." ' ,TO TME ASS.. :S OF THE LEUDING INSTI. Lariat �/ ;447',,,k,,- ,I d"'•:%;? 'a,g, • - 1. . TUT10N.GUAR .1TCE5 ARE NOT TRANSFERABLj L FC�K��d a.GrC�i7 y r r� •r �'�i Ja•(�1'V,._. , , 1' TO ADDITIONAL WSTRLITIONs OR SUBSEQUEN( 6 �L—_�, i �/ -• , }^ S • OWNERS. 1 Green/26.°# Mew etrk • , `