HomeMy WebLinkAboutDuffy lily" latf OL4r4
ffra Town Hall, 53095 Main Road
`' P.O. Box 1179
41,® °� ►� Southold, New York 11971
JUDITH T.TERRY 765-1823
TELEPHONE 16)765-1801
TOWN CLERK
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. 1304-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DUFFY, JAMES AND MARY ELLEN
Mailing Address 1 WUNNEWETA ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 WUNNEWETA ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5980
Tax Map No. section 111 .00 block 8 lot 16.000
Cross Street CARRINGTON ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 11/13/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
ir
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OFFICE OF THE TOWN CLERK ' OfFOUr
Town of Southold ®� 4 Application No. /309
Judith T. Terry, Town Clerk
zh'
r`"`fY " $10.00 - Residential
Town Hall, 53095 Main Road ^+
P. O. Box 1179 RO
w :� ���� ��� $25.00 - Non-Residential
Southold, New York 11971 O ® '':O�eP
Telephone -'1q1 `t�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /O
DATE 0/%%/
OWNER NAME: 7q-' -rv,c-•
OWNER MAILING ADDRESS:
22'L�- /1
a u
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: S,(o 7 3 � 3'7d9c)
TAX MAP NO. : Section i f. I Block e Lot
CROSS STREET: ( +�/�,c�-a�Ec �
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool --( New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: �yt� � p� u /0y-1-111-4/t./7 t
- 7s,L
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.)
J4.0
Si%ature of Applicant /
RECEIVED BY:
Town Clerk's Office
DATE:
61111- (4)14-it
C CLA .ea-e.fr Rd
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