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HomeMy WebLinkAboutGeneral Wayne Inn OFFICE OF THE TOWN CLERK c� FOLA' , Town of Southold Judith T. Terry, Town Clerk � - ' Town Hall, 53095 Main Road . P. O. Box 1179 Southold, New York 11971 \ O � Telephone :'®1 � (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation. Permit No. NR58 Residential Fee $ 25.00 Non-Residential x Septic Cesspool x NAME OF OWNER: General Wayne Inn, Inc. OWNER MAILING ADDRESS: Cedar Beach Road Southold, New York' 11971 OWNER PROPERTY ADDRESS: Cedar Beach Road Southold, New York OWNER TELEPHONE NUMBER: 516-765-3344 TAX MAP NO. : Section 89 Block 3 Lot CROSS STREET: Main Bayview Road TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New Existing X Residential Non-Residential X DATE OF PREVIOUS PUMP-OUT: Unknown Judith T. ry Southold Town Clerk DATE: January 5, 198R (TOWN SEAL) U I III• OFFICE OF THE TOWN CLERK �I�FFO Town of Southold �o� tCQ Application No/Ui'3 Judith T. Terry, Town Clerk #" "w Town Hall, 53095 Main Road �' `"` ` � Residential P. 0. Box 1179 07-65;,D' y �' _ Non-Residential Southold, New York 11971 ® '` �f Telephone • _ 1 (516) 765-1801 TOWN OF SOUTHOLD RECEIVED SOUTHOLD WASTEWATER DISPOSAL DISTRICT DEC 311987 Tnwn Clerk Southold APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE (2-/-2-7 /37 OWNER NAME: ��N �P �- W 1}"`iv a 1-1u j 0 AK- OWNER MAILING ADDRESS: O i)fl-R B P -I4 R d PrI) 0 U T-jf o L-D1 Al. I I 1 1 1 OWNER PROPERTY ADDRESS: .619-Me. OWNER TELEPHONE NUMBER: l(o C_ 44 LI TAX MAP NO. : Section t7v 0 0 Block o • ©0 Lot CO , 0 00 CROSS STREET: WON 81)--11) 11r) k t?} D TYPE OF SYSTEM: Septic Tank New Existing Cesspool V New Existing Residential Non-Residential 1// 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.) -5i n ture of Applica t g pp RECEIVUI®BoY� 4 44 Ftt ron Clerk's Office DATE: JAN 0 0 1404 sow4hold Town Mutt ' � -- • ' _-____�_-___-- ^ . . . . ^ . . � . V', •", � � .10 ..` � � �� ' � � . -~~ �/