HomeMy WebLinkAboutBookmiller OFFICE OF THE TOWN CLERK s 'r0FU(�'`,'
Town of Southold O� sem, �
Judith T. Terry, Town Clerk • , t# )s.*%
Town Hall, 53095 Main Road k
P. 0. Box 1179 "VV,
\�k „„, 7.4
Southold, New York 11971 ti ®{.41-0°
Telephone
(516) 765-1801 _
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 124 Residential x
Non-Residential
Fee $ 10:00
Septic Cesspool x
NAME OF OWNER: Brent arid Colleen Bookmiller
OWNER MAILING ADDRESS: P.O. Box 46
Laurel, New York 11948
OWNER PROPERTY ADDRESS: 4425 Eeconic Bay Blvd.
Laurel, New York
OWNER TELEPHONE NUMBER: Bus. 516-722-4433 Home 516-298-4526
TAX MAP NO. : Section 128 Block 3 Lot 17
CROSS STREET: Delmar Drive
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential x Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Ter
Southold Town Clerk
DATE: November 5, 1986
(TOWN SEAL) -
.
OFFICE OF THE TOWN CLERK 'C3\\VHU(
Town of Southold �� CQG' , Application No /07
Judith T. Terry, Town Clerk .� al � °; y
Town Hall, 53095 Main Road o Residential
P. O. Box 1179 (-1/ ��, ��.`� Non-Residential
Southold, New -York 11971 0�0�
Telephone - ��0�'�.•
��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
RECSV D for
®V 05� o� OPERATION PERMIT
TOM CST 9311"16
SEPTIC TANK or CESSPOOL
Operation Permit No. /? T
Fee $ ) ®®®®
DATE 11 S69
OWNER NAME: 51 ij (:,,,,,,[)'\ ((eci
OWNER MAILING ADDRESS: P O . f3Ox 116
OWNER PROPERTY ADDRESS: 1-/- L 5 P Loi t 6/9-ii 8J ,d
j Ua- Q / i .
rr
OWNER TELEPHONE NUMBER: A.S - 2-2--Pt23 ticl1-2- — Y".5— 6
TAX MAP NO. : Section j 3 8' Block 3 Lot / 17
CROSS STREET: De..9-41/‘-a/) 60,4 J ZiffN 62J
TYPE OF SYSTEM: Septic Tank - New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: (/1)-(/] 'L/e- OL4 1JOkJt .5j/es
LOCATION MAP: Must be attached hereto before permit may be issued. h
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
pp
Signature of Applicant
g
RECEIVED BY:
Town Clerk's Office
DATE:
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NOTE : IN = MONUMENT • \ �/ PE0
REVISIONS - YOUNG & YOUNG_
NOV. 30, 1977 400 OSTRANDER AVENUE, RIVERHE• . t1 OF i• 'j
-_��pp UU�� 0�q
• - ALDEN W. YOUNG -,kt�v�/ARfl Yi5►NG
• PROFESSIONAL ENGINEER AND D ANI, URVp-
-- - LAND SURVEYOR, N.Y.S. LIC. NO. 12845 VL N "•$cr, NOZ -89
SURVEY FOR: '7 Ili,,,A,01 ;t
UNAUTHORIZED ALTERATION OR ADDITION TO Sim
THIS SURVEY IS A VIOLATION OF SECTION JOHN J. BERDI N KA ft)
7209 OF THE NEW YORK STATE EDUCATION
LAW. • ei 41O. 45893
COPIES OF THIS SURVEY MAP NOT BEARING
THE LAND SURVEYOR'S INKED SEAL OR rFy�Fo LAND sati
•--o%
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY - AT LAUREL GUARANTEED TO:
SECURITY TITLE& GUARANTY CO.
GUARANTEES INDICATED HEREON SHALL RUN THE NORTH FORK BANK & TRUST CO. ',
ONLY TO THE PERSON FOR WHOM THE TOWN OF S O U T H O L D
SURVEY IS PREPARED,AND ON HIS BEHALF
TO THE TITLE COMPANY,GOVERNMENTAL
AGENCY AND LENDING INSTITUTION LISTED
HEREON,AND TO THE ASSIGNEES OF THE SUFFOLK CO., N.Y. BY � 4-' -7 -
LENDING INSTITUTION. GUARANTEES ARE
NOT TRANSFERABLE TO ADDITIONAL SCALE: 111'=401 DATE:APRI L 25, 1977 I NO. 7 -243
INSTITUTIONS OR SUBSEQUENT OWNERS. - J./
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