HomeMy WebLinkAboutHodgson ' Town Hall, 53095 Main Road
0:1, �A-,+'�,�� P.O. Box 1179
�� Southold, New York 11971
JUDITH T.TERRY `-.., �' FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1549-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HODGSON, WILLIAM
Mailing Address 1 BOX 53
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 2995 VANSTON ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7355
Tax Map No. section 111 .00 block 6 lot 9.000
Cross Street CARRINGTON ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 10/23/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK 'S�FFD(,rC'
Town of Southold � ; Application No. /SW
Judith T. Terry, Town Clerk \ �
Town Hail, 53095 Main Road - =` rG $10.00 Residential /
p. O. Box 1179 cry z= $25.00 - Non-Residential
Southold, New York 11971 O - •
Telephone
Telephone '07i 'Y►;
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0:00
DATE /0 - 9- ?O
-OWNER NAME: I a L. . i A- ? � Cho a)
OWNER MAILING ADDRESS: o)( 33
x..6/..67, .4/7
OWNER PROPERTY ADDRESS: • 9 i//9 Aiss.7-9 4/ # 4�
OWNER TELEPHONE NUMBER: 7..g -
TAX MAP NO. : Section /1/ / Block 6 Lot ?
CROSS STREET: C/1 .C., -e4/ ,g-2)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing ✓
Residential / Non-Residential
DATE OF PREVIOUS PUMP-OUT: ago/ 2 JN /978' r9v/r90a. "-.4. 7
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.)
th 1 J
Signature of ptlicant
RECEIVED BY:
Town Clerk's Office
DATE:
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