HomeMy WebLinkAboutEvans Town Hall, 53095 Main Road
' ® P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY `� TELEPHONE
TOWN CLERK (516) 765-1801
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. 751-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner EVANS, ELIZABETH M.
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Mailing Address 1 HAINES, BARBARA M.
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Mailing Address 2 P. O. BOX 443
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City St Zip CUTCHOGUE NY 11935-0000
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Property Address 1 MOORES LANE
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Property Address 2
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City St Zip CUTCHOGUE NY 11935-0000
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Owner Telephone No. 516-734-6539
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Tax Map No. section 109. 00 block 4 lot 2. 000
Cross Street ROUTE 25
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Date Of Last Pump Out 0/00/79
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Issue Date: 7/11/88 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
�FF�(�.
1 Town of Southold �� CQG Application No. -7
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road _ -� Residential
P. 0. Box 1179 cry Non-Residential
Southold, New York 11971 O
Telephone.!
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10.00
DATE July 89 1988
OWNER NAME: Elizabeth M. Evans and Barbara M. Haines
OWNER MAILING ADDRESS: p. 0. Box 443
Cutchogu.e, N. Y. 11935
OWNER PROPERTY ADDRESS: Moores mane
Cutchog°ue, N. Y. 11935
OWNER TELEPHONE NUMBER: (516) 734 6539
TAX MAP NO. : Section 109_ Block 4 Lot 2
CROSS STREET: _0u TE 9,6'
TYPE OF SYSTEM: Septic .Tank New Existing
Cesspool y, New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1979
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.)
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Signature of Ap lica t
RECEIVED BY: � � P , )
RjCWGCIerk's Office
DATE:- .110 I 1 ') 1988 RNQVRDO
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