HomeMy WebLinkAboutCutchogue Fishermans rest OFFICE OF THE TOWN CLERK • "
Town of Southold � F yr.•.i
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971 CO �`-
Telephone ' Ol �
(516) 765-1801
TOWN OF OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR 17 Residential
Non-Residential XX
Fee $ 25.00
Septic XX Cesspool XX
NAME OF OWNER: Cutchoque Fisherman's Rest, Inc.
OWNER MAILING ADDRESS: Main Road
Cutchogue, New York 11915
OWNER PROPERTY ADDRESS: Main(Road
Cutchogue, New York
OWNER TELEPHONE NUMBER: 516-734-5155
TAX MAP NO. : Section 102 Block 6 Lot 1 7
CROSS STREET: New Suffolk Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: September 1986
Judith T. Terry
Southold Town Clerk
DATE: Qctpber21 , 1 986
(TOWN SEAL)
1
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OFFICE OF THE TOWN CLERK Fp(,r
Town of Southold �o CQG Application No. 0
Judith T. Terry, Town Clerk � "`
Town Hall, 53095 Main Road o Or
, '� Residential --
P. O. Box 1179 v' '4' ` Non-Residential
Southold, New York 11971 O ® �$
Telephone :0( ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT �U�CyOC
U' 2.t 1986 SEPTIC TANK or CESSPOOL Uc:'
Town Cleric Southold, $ Cop, `gO.a ~• .
'1O4i 4
S
P
®/bOperation Permit No. AJ.t/7
Fee $-_-_2(5- " 4/9`
DATE 4
OWNER NAME: •ife "- 7 ikoe C.
OWNER MAILING ADDRESS: Mid 'R
OWNER PROPERTY ADDRESS: . ,
OWNER TELEPHONE NUMBER: `./ 2� V"' zj I-
TAX MAP NO. : Section Block Lot /7
CROSS STREET:
i/ •
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential �7
/7 Non-Residential
qty•
DATE OF PREVIOUS PUMP-OUT: f//�f" -��"�u
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.)
1dA6/111/Vign-ature
CjofApj icant
RECEIVED BY: (,ea
Town1lerk's ffice
DATE: ,, o,2/, /�I-
i r!„", 7 Ana _" - -
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