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HomeMy WebLinkAboutCross Sound Ferry } >' a Town Hall, 53095 Main Road . ,'� P.O. Box 1179 ® ��••► Southold, New York 11971 JUDITH T.TERRY '- 40.', TELEPHONE 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. 65-N Residential Non-Residential X Fee $ 25. 00 Septic Cesspool X New Existing X Name Of Owner CROSS SOUND FERRY Mailing Address 1 C/O JOHN CADWALLADER DOCK ROAD City St Zip ORIENT NY 11957-0000 Property Address 1 DOCK ROAD City St Zip ORIENT NY 11957-0000 Owner Telephone No. 516-323-2761 Tax Map No. section 15. 00 block 9 lot 11.100 Cross Street MAIN ROAD (ROUTE 25) Date Of Last Pump Out 0/00/00 Issue Date: 4/18/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) .s OFFICE' OF THE TOWN CLERK ` ,•� F® / Town of Southold ��� COQ-. ; Application No. e[� Judith T. Terry, Town Clerk , Town Hall, 53095 Main Road ' Residential P. O. Box 1179 Fr" , e� `. Non-Residential" Southold, New York 11971 ® ��` Telephone .( (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ e41/ ,--1,pr DATE / 1(,cr,5s Ste. f�►� C69(�1o69�G fir. OWNER NAME: CJt OWNER MAILING ADDRESS: OG (Gf • r&VIf— y it � c7 OWNER PROPERTY ADDRESS: S r'"`e �> OWNER TELEPHONE NUMBER: 3 2 3 2-77 / TAX MAP NO. : Section Block Lot //.. / CROSS STREET: 9 lee. TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: 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.) int Signature of Applicant RECEIVED BY: Town Clerk's Office DATE: • i s c p19 ?,-ce--Lj , sc , 0, /-0 �➢� f 0 v ,0 1 • ‘ . ,,, ,-.20- i , --. ._....4 --,...„ 6 ,0 , © „, b 1 0/ r j r i c ,i ,E., V