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JUDITH T. TERRY c Town Hall, 53095 Main Road
TOWN CLERK c to
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER c? Fax (516) 765-1823
®?� 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. 1996-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DANSEREAU, AGNES R.
Mailing Address 1 57185 NORTH ROAD
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 57185 NORTH ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1387
Tax Map No. section 44.00 block 2 lot 2.000
Cross Street ALBERTSON LANE
Date Of Last Pump Out 0/00/00
Issue Date: 10/21/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
eFFICE OF THE TOWN CLERK c�uFFOC,('r'=
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A, • •
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK j 4 P.O Box 1 179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER - , Fax (516) 765-1823
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
October 14, 1992
Agnes Dansereau
57185 County Road 48
Greenport, New York 11944
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Re: 44-2-2 9/92
Dear Ms. Dansereau:
Our records indicate that you recently had your cesspool/septic tank system
pumped out. According to the Southold Town Scavenger Wastes Ordinance,
any owner of an operating, on-site sewage disposal system, such as a septic
tank or cesspool, must obtain an Operation Permit for that system.
The Operation Permit is issued by the Southold Town Clerk's Office. The
fee is ten dollars ($10.00) for a residential system, twenty-five dollars ($25.00)
for a non-residential system. You will not be asked to obtain an Operation
Permit each time you have work done on the system. The permit is only issued
once for each system.
Enclosed is an application for an Operation Permit. Please complete the
application and return it to this office along with the location map and proper
fee. (NOTE: The location map may be a copy of your survey with the location
of the cesspool(s) indicated or a sketch of your property showing the location
of the buildings, cesspool system, and approximate distance in feet to buildings
and closest road.), Also included is an Informational Bulletin regarding the
Southold Town Scavenger Waste Treatment Facility. I hope this will aid you
in understanding the Scavenger Wastes Ordinance.
Please do not ignore this request. Should you have any questions or need
any assistance with the application, please do not hesitate to contact this office.
We will be happy to assist you in any way we possibly can.
Very truly yours,
• •
Judith T. Terry
Southold Town Clerk
Enclosures (2)
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