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HomeMy WebLinkAboutBondarchuk (2) OFFICE OF THE TOWN CLERK • FE Town of Southold ex Judith T. Terry, Town Clerk � : * Town Hall, 53095 Main Road a P. 0. Box 1179 , �iq '* Southold, New York 11971 \ }{ , Telephone - _0l • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 567 Residential X Non-Residential Fee $ 10.00 Septic Cesspool X NAME OF OWNER: John J. Bondarchiak and wife OWNER MAILING ADDRESS: 805 Navy Street Orient, New York 11957 OWNER PROPERTY ADDRESS: 805 Navy Street Orient. New York 11957 OWNER TELEPHONE NUMBER: 516-323-2626 TAX MAP NO. : Section 25 Block 3 Lot 19 CROSS STREET: Orchard Street TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing x Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: 12-31-84 Judith T. Te Southold Town Clerk DATE: January 8, 1988 (TOWN SEAL) • :.. OFFICE OF THE TOWN CLERK c,�FFO(,«r Town of Southold ®�® � Application No. 7 Judith T. Terry, Town Clerk ‘4=4 Town Hall, 53095 Main Road wAtAy' G 1 Residential P. O. Box 1179 can ; Non-Residential Southold, New York 11971 z " • S Telephone _01 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No.�j 7 Fee $ , . VA) DATE / a _ 3 i "- � � OWNER NAME: --1 o k n J OWNER MAILING ADDRESS: 80c Am_vY Sr Coei-egir- 5-7) ©Rte.,Ji ! V, y,c7 - oases OWNER PROPERTY ADDRESS_ e OWNER TELEPHONE NUMBER: W7e) TAX MAP NO. : Section ilfg, Block Lot L CROSS STREET: TYPE OF SYSTEM: Septic Tank r New Existing Cesspool [. New Existing Residential Non-Residential DATE OC PREVIOUS PUMP-OUT: ,4R/.3, fry 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: Town Clerk's Office DATE: R` MAP CP- PQCP .ZiY 4i SuRVEN'E D FOR -i JOIN J. BETTYJANE BON LAR.CHUK .1 AT . W OCL1 ENT` f 0 Ay�R` i TOWN OF SOLITHOLO N'�! N- i < to ,.__,S•81°09r00,� .i h F'-". .-4-/- . I43I i - ,rt duty -----5. i . , to ! � v T �t { i Y 0 r 0 - TN' I ®` o ,cps _ 411 �\ ` U 1 L' i J II- t 43 v ` Ili W C df� et a _O 9, y nautho:irnd alteration or addition JI r-, y, 3 � }I this survey is a violation of I ° Q. phi ° ? ion 7205 of the New York X30 e d' 0 0 Q I ducation Law. >� c _�- FeMc�_a't "or4h I fn 2: l ,r.Mad of this survey map netisa&rtn d surveyor's inked seal et 1 N.84°15'20'W. - • ei'r,,bcssed seal shall not be ooneidor6� 146 �5 tp be r valid true copy. I sumer/usrento.s'In,ticrted haroon Moil run i 'drily to the person(or whom the sumer/ ! RI C HA R pS i#prepared.and on his L hoIf to the We company,government&I agency and ++ I nder.Z institution listed hereon end t the assignees of the landing insti- 1 t Guarantees are not transferable cq:ari•t,ensl institutions or subsequent I t I 0 l 1• 01 SCALE-50 t1 , - 0. !ROt•a PIPE • I A 1 • i GUARANTEED TO THE SOUT ;OLD SAVINGS _2] BANLCII HOME TI'T'LE DIV.-C.T LC. t AS SURVEYED JAN 9,19 7 5 VAN TUYL -SON NAVY ` ___' . — — —_-- / \I �,:. •fi - I - — LICENSED LSO S_o- E' (aS ~ EEr-aPO T IN,Ly ----- j i 1