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Town Hall, 53095 Main Road
*$ P.O. Box 1179
;�® 1-: 5^.,' ®��.`� Southold, New York 11971
01 TELEPHONE
JUDITH T.TERRY,,��, t°1° (516)(516) 765 1801
TOWN CLERK
REGISTRAR OE VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 77-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner BIDWELL, ROBERT E.
Mailing Address 1 27 MONTROSE PLACE
Mailing Address 2
City St Zip MELVILLE NY 11747-0000
Property Address 1 ROUTE 48
Property Address 2 BIDWELL VINEYARD
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-643-2444
Tax Map No. section 96.00 block 4 lot Lear 3=
Cross Street DEPOT LANE
Date Of Last Pump Out 0/00/00
Issue Date: 11/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �'' i , FO(,(' -
Town of Southold � , L'0 Application No.NR77
Judith T. Terry, Town Clerk :,t -.y
Town Hall, 53095 Main Road " �� `, .�� ' Residential
p. O. Box 1179 c8-3 ; Non-Residential
Southold, New York 11971 O ,4111‘• •O� es
Telephone ?i A `j►
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for •
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit NoAA 7 7
Fee $ 25 .00
DATE October 11 , 1988
• OWNER NAME: Robert E . Bidwell
OWNER MAILING ADDRESS: 27 Montrose Place
Melville , New York 11747
OWNER PROPERTY ADDRESS: Route 48
Cutchogue , New York 11935
OWNER TELEPHONE NUMBER: 516/643-2444
TAX MAP NO. : Section Block Lot V
CROSS STREET: Depot Lane
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: Ate_1/�/�
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of dist4nce, approximately, to building and closest road.)
Signature of Applicant
RECEIVED BY: r% i %/ q� //
1111r: n ' erk' Office
DATE: 6 oZ5AJ
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]3IDWELL V1 rYl 1K D6 NORTH LONG FORK
CUTCHOGUE, NEW YORK 11935
PHONE (516)734-5200
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