HomeMy WebLinkAboutMaxwell JUDITH T. TERRY . Town Hall, 53095 Main Road
TOWN CLERK • ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS : 6l' : Southold, New York 11971
Vo®� Fax (516) 765-1823
MARRIAGE OFFICER
‘.7,210. 0 Telephone�� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1785-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MAXWELL, ADELE
Mailing Address 1 BOX 756
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1645 CALVES NECK ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3795
Tax Map No. section 70.00 block 4 lot 49.000
Cross Street MIDFARM ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 10/09/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c�VFFO(A'��=
Town of SoutholdCQG' Application No./ 1e0
Judith T. Terry, Town Clerk k $fv.
Town Hall, 53095 Main Road _ $10.00 - Residential
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P. O. Box 1179 cr2 � ' n �' $25.00 - Non-Residential
Southold, New York 11971 O I
Telephone
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
`- - �- •- for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ f01. *
DATE 7 Oe /9
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OWNER NAME:
OWNER MAILING ADDRESS: /57e) r
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OWNER PROPERTY ADDRESS: _._ _ C_ _
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OWNER TELEPHONE NUMBER: 73 c9"
TAX MAP NO. : Section /i53 Block - ( Lot Z�
CROSS STREET:
TYPE OF SYSTEM: Septic Tank . New Existing
_ Cesspool New Existing V
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 9 `7 9 glp
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.)
Signature of Applicant
RECEIVED BY: .
Town Clerk's Office
DATE:
MANUEL M. CABRAL
1800 HARBOR LANE
CUTCHO®UE, LONG ISLAND
NEW YORK 11935 -.
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