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JUDITH T.TERRY ` o�®
�1� ‘ Town Hall, 53095 Main Road
TOWN CLERK P.O.Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %%1.16
MARRIAGE OFFICER %y� ®�,�1 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER of 4.00 Telephone(516) 765-1800
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. 3627-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner ENOS, HUGH AND KATHLEEN
Mailing Address 1 1425 HARBOR LANE
Mailing Address 2
City St Zip CUTCHOCUE NY 11935-0000
Property Address 1 1425 HARBOR LANE
Property Address 2
City St Zip CUTCHOCUE NY 11935-0000
Owner Telephone No. 516-734-4154
Tax Map No. section 97.00 block 6 lot 9.000
Cross Street MAIN ROAD
Issue Date: 5/15/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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'OFFICE OF THE TOWN CLERK
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60--`7
Town of Southold , Application No.
Judith T. Terry, Town Clerk $ ;� ,�
Town Hall, 53095 Main Road g * < ; :4 $10.00 - Residential
P. O. Box 1179 cry }4*4 : ;' $25.00 - Non-Residential
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Ctct
\ Operation Permit No.
J Fee $
�J DATE S./ i )
OWNER NAME: 1.1(4,1 ii-c44-kk to 4CntS
OWNER MAILING ADDRESS:
— — —OWNER PROPERTY ADDRESS:
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CUl7��CS%c• q3J
OWNER TELEPHONE NUMBER: 5U -73'( - W�Sy
TAX MAP NO. : Section ¶7 Block 4 Lot r-60
CROSS STREET: 11Aatlk (- 0J
TYPE'OF' SYSTEM: Septic Tank % New V Existing
Cesspool 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.)
•Signature of Appl`l ant
RECEIVED BY: - -
Town Clerk's Office
DATE:
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