HomeMy WebLinkAboutHopkins %VD
01`-
diY
=4
' y Town Hall, 53095 Main Road
e�®a N-Vii` P.O. Box 1179
��' Southold, New York 11971
JUDITH T.TERRY FAX(516)765-1823
TOWN CLERK TELEPHONE(516)7654801
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. 1015-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HOPKINS, ROBERT WARD
Mailing Address 1 253-35 MAIN ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 253-35 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5816
Tax Map No. section 109.00 block 2 lot 11 .000
Cross Street CROWN LAND ROAD
Date Of Last Pump Out 0/00/86
Issue Date: 2/10/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK COMA'
Town of Southold - CQG' , Application No. 1 /S
Judith T. Terry, Town Clerk -it, y
Town Hall, 53095 Main Road I Residential
P. O. Box 1179tr31 ; Non-Residential
Southold, New York 11971 , -s_,o���`�
Telephone .� ',
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /13j.3
D0
Fee $ /(5 .-
DATE
(5DATE
OWNER NAME: fRc)e)570-/ Id? ✓U��/),?' it5-
OWNER MAILING ADDRESS: r�c13a/Ili i LC�orti
ect Pb®+ctle , ),r //y
OWNER PROPERTY ADDRESS: - Main) 1-aa((
ec,ific/' <-6/1'. !U91. /H.? j
OWNER TELEPHONE NUMBER: 93'/- 01
TAX MAP NO. : Section /0 9 Block Lot //
CROSS STREET: / ow N 4. 444gt /Q60
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: / g'6
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.)
F
e
Signature of Apiplicant
RECEIVED Bi ,, ;
` .wn Clerk's Office
DATE: FEB1 0 1909
~
.-~
,
- ' _____--~
\ -i -"Sf __
/-i ty
xv
/ " /
| > :
t 1I
|
-~�(� '
} \
` .~
I! /
/
P i--- . I
`
___._____________ i____,_ _ -_
-
._ _ _
__ __
/
� , / \ /1 /�` � /�. )
` � �Y / /\/ / `~-
--'
;IYi
;11
3�' -
< :''� � � � �-
�J ' - � . '