HomeMy WebLinkAboutJohnson (3) cOe
$� fi Town Hall, 53095 Main Road
tki fi) P.O. Box 1179
,ss22, _ Southold, New York 11971
JUDITH T.TERRY 11 a `?S ,-. TELEPHONE
�1.�^...
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. 3565-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner JOHNSON, BRUCE R.
Mailing Address 1 3765 STILLWATER AVENUE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 3765 STILLWATER AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6194
Tax Map No. section 137.00 block 1 lot 1 .000
Cross Street MAIN ROAD
Issue Date: 12/24/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/
OFFICE S�F
•OF THE TOWN CLERK FOUr 355&
•It Town of Southold �� CQ '_, Application No.�
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road 1 4 $10.00 - Residential
P. O. Box 1179 $25.00 - Non-Residential
Southold, New York 11971 ���`
Telephone 1 . ��o ' •�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 12/10/96
OWNER NAME: Bruce R Johnson
OWNER MAILING ADDRESS: 3765 Stillwater Avenue
Cutphogue, NY 11935
OWNER PROPERTY ADDRESS : same as above
OWNER TELEPHONE NUMBER: ( 51 6 ) 734-6194
TAX MAP NO. : Section 137 Block 1 Lot 1
CROSS STREET: Main Road
TYPE OF SYSTEM: Septic Tank X New Existing Xa
Cesspool New Existing
Residential X Non-Residential
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.)
Ampai,
Signa _ of Applicant
RECEIVED BY: •
Town Clerk's Office
41
DATE:
•
' —fir}+. _ ...-syr ri. y4 ,
•
ry
+i:.' •-'. r "'fi•1'.�•k' {L{' .. �`'? = '�..7.4r".4•+^ S aw :," ;v \ •�=� 7�•. .4-S.A�+•.. .r..rL" YI .,` ..... �y�.•
--1' 11 �
,•fV" t _..vi nr'Li.• YL '••¢` `. • '.�(. • _-T, • ♦ ' y�,-,�,� •., �.; 1:� �• ��•,,yti.1--"%.l . i" 3'
itip•
'4%; 1,��l f. -a ►y"�'�1,r'� F.Yi'-'t y :',-+ % -i•-•• 1}:-44-P • • ./V..%r. *J.:0'IC4 . � %. �~ �y� Sri• T ,.� •••1--"‘S.4';:•_,t - .t� a�:i..7►7}- • r. ( r�
''�j..�•. "`G: ..,"►'— •• \:._i t•-!� ' �,�r?'^'ni,`r{1• J'.�' :C'•1; '�•- ,1 - 4';' 4 2' •Cr-.,:t„,,,,....• tL+ v
. .
Y••t•' , 7 "'r i :� 1.-. . �%:t'•_ in ai„T:'-•. .• • .`-.•: • � : �"-++ r-!' r 7....11, = t. `,_••}..' %11�-• .I
„ ,-, i•.,•.` ,7,.:,:A n r71'L,-. .S i-'0.1.41'1...,4",,,,,,:c.•••••_*,,,....'
T-ry �'v,�tiMss r'.o •4'! .' •4-•_,..e_0y7?”'. --:.>,,171 Pe : T.='- r .� K ;�'• ��•�,7F=. • -- •=f t.
kr�,�;�s , •
.. . -• ,`; .I',-. -�•1/4.1.... .i...::......-,,,--..,..
A+f• �Q� yt jr? :'" ^C;z •;'.�Of* • 4 -j�-K� yti..:..s yr- •:•;.:(4-4,4*.t!i ,••• i:-•t a •: