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:- Town Hall, 53095 Main Road® ' V ®� �� P.O. Box 1179
7_-�®� .i. Southold, New York 11971
JUDITH T.TERRY ` '�"� FAX(516)765-1823
''% ������` TELEPHONE(516)765-1801
TOWN CLERK
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. 1411-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HYDELL, JOSEPH
Mailing Address 1 325 OAK AVENUE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 325 OAK AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5914
Tax Map No. section 77.00 block 2 lot 11 .000
Cross Street CEDAR AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 3/13/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
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tOFOC,r
Town of Southold CQ ' A lication No./4//,2
Judith T. Terry, -�
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Town Clerk � y
~ `�`� '�� �� � $10.00 - Residential
Town Hall, 53095 Main Road :� `: :'�
P. O. Box 1179 CS3_ $25.00 - Non-Residential
Southold, New York 11971 0
Telephone 1iat
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
- OPPL IrATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ (-72)
DAT E-a 7 7t)
OWNER NAME: C? S 1-- �`� HytLL
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OWNER MAILING ADDRESS: 3 "Th 5-2;4:0/M.' k
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OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 77 Block `2 Lot / /
CROSS STREET:
TYPE OF SYSTEM: Septic Tank V
p New Existing
Cesspool i/ New Existing 1/7
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,'tr,/1, (kvyiki f)te4 4/0Y Af42,4 /
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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Si./ature of Ap/cant
RECEIVED B Y: (torr n J (//-1/9-_,97/t&
REC Clerk's Offic
IVED
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Town Clerk Southold
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