HomeMy WebLinkAboutDennison ce-
JUDITH T. TERRY • Town Hall, 53095 Main Road
TOWN CLERK : ® `,'if'
P.O. Box 1179
trzSouthold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER 4 ANb Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ®1 P..01°
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3228-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner DENNISON, JOHN R. AND INEZ F.
Mailing Address 1 P. 0. BOX 55
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 45 CEDARS ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6750
Tax Map No. section 109.00 block 6 lot 17.001
Cross Street CASES LANE
Issue Date: 8/01/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK 'c�0FD(,(��'
Town of Southold CQ Application No. ojL��
Judith T. Terry, Town Clerk ';' r, �
:war $10.00 - Residential c
.G
Town Hall, 53095 Main Road " -
P. O. Box 1179 Cr' '� � $25.00 - Non-Residential
-Rt,Southold, New York 11971 O s ,; ' � �
Telephone = 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. S ,
Fee s/& ---
DA T E 7•
'
•
OWNER NAME: \%///V ? %CZ• A 06.-NiV/So
OWNER MAILING ADDRESS: ,'O- �(
C' , y //93,1-
OWNER PROPERTY ADDRESS: 4.S- CC444S• 490
rOX-WaGIc/ ,.y, //73
OWNER TELEPHONE NUMBER: �kr/G) 73 - 67<^o
TAX MAP NO. : Section /0 7 Block 06. 00 Lot 0/ 7, 00)
CROSS STREET: 7--�� 67/f)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential ✓ Non-Residential
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.)
•;- / e4/4444,-
ez;
Signature of Applicant
RECEIVED BY:
Town Clerk's fice
DATE: -7/ �j/ 9/
. •
. ,
,.
. • ,
, - , --, ,`,-.%4•'-,,Q,-
.
, .
, .
, .
, . •" . ,
•
. .
. .
, .
•
, ,, .,,•'
' ;',,,, • •
, .
•
1
I .
,.•,_' ,,,,
1 .
- '
1 .
I 1
. .
r ,
ill .
•,.
. .
1 i •
. ,
- • ,, c.
. ,
,
z ' -- 0'6.1
iz:j
I i
., -----,----CLI>E5---------
__.__..
,
.iii
..„
______
.......__
. ..
/UV
if '
'A 1/
I
-0
-1
1
' I
r ' I i , I '
4 ..
\S' '' , , '\i'.'',' •
Ni\ \: "N‘
kN'
..1
\.,N\\N, \
,SX
V
. ",.
. .
. .
. .
. , .
, ....---
' • `....74944_-_..K., Isoz,..F.".1,---swkziti.-:
, .
. .
_____
\._ .
_
,
.