HomeMy WebLinkAboutHorowitz JUDITH T. TERRY % ; a �, Town Hall, 53095 Main Road
TOWN CLERK „ k ` P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ; f� a .
Southold, New York 11971
� ��, �h,�•'° Fax (516) 765-1823
MARRIAGE OFFICER #.o$ir, Telephone (516) 765-1801
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OFFICE
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1778-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HOROWITZ, RUTH B.
Mailing Address 1 P. O. BOX 814
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 3500 NASSAU POINT ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6653
Tax Map No. section 111 .00 block 4 lot 33.000
Cross Street OLD MENHADEN AND VANSTON ROADS
Date Of Last Pump Out 0/00/00
Issue Date: 10/08/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK o CS Fait'
Town of Southold % CQG Application No. /77
Judith T. Terry, Town Clerk ] ; y
Town Hall, 53095 Main Road $10.00 - Residential r�
P. O. Box 1179 col Ex-, Win
$25.00 - Non-Residential
Southold, New York 11971
Telephone 90 )00.•�`�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. -
d
Fee $ JOfry'
DATE / o / y / /
OWNER NAME: k U T4"0 9- ® A. D 1.4.,' Z
OWNER MAILING ADDRESS: f. O . 19 6 / Li
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OWNER PROPERTY ADDRESS: 3 S-0 0 /V IA-sr U t (R/% A B l4-fl
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OWNER TELEPHONE NUMBER: 57 6 - 7 3 V- (v 6 c 3
TAX MAP NO. : Section if ) Block Lot 33
CROSS STREET: OLD MgN"ti- A1) c-bt! 4 VA-it/S j 4 fV
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing l/
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: zkko. - e tt ti - "'�
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 Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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