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OFFICE OF THE TOWN CLERK ' \SWFQ!4(
Town of Southold , NY,-�.f .� CQ�
Judith T. Terry, Town Clerk +
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Town Hall, 53095 Main Road g - ,=
P. O. Box 1179 2ti3 ,
Southold, New York 11971 ON r �'�
Telephone -
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2 Residential
Fee $ 25 . 00 Non-Residential XXX
Septic Cesspool
- NAME OF OWNER: MAJAMEG CORP . D/B/A The Quiet Man Inn--
OWNER MAILING ADDRESS: The Quiet Man Inn
Main Road, Southold. N.y . 11971
OWNER PROPERTY ADDRESS: same
OWNER TELEPHONE NUMBER: 765-9887 ;21
TAX MAP NO. : Section 62 Block 3 Lot 7
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CROSS STREET: Hobart Road
TYPE OF SYSTEM: Septic Tank New Existing
OIL
Cesspool XXX New Existing XXX
Residential Non-Residential - XXX _
DATE OF,•PREVIOUS PUMP-OUT: 7/28/86 P .U. Cesspool
u afei..4-7121-71r;e1; --..
Southold Town Cle
DATE: 8/15/86
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �CSFCU( -
Town of Southold ® Application No.
Judith T. Terry, Town Clerk ' I, 1~ �'` Residential `
Town Hall, 53095 Main Road o _- �;. -
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P. O. Box 1179 �' � '� . Non-Residential
Southold, New York 11971 �0
Telephone . 1 a [
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 6-'.
DATE g" I a- g6
C.
OWNER NAME: NAJ4 a 6,,er .be),_.be),_ 1_, ac),„,- A) /,
OWNER MAILING ADDRESS: MA-/TO koA4
'c37-61-ee1.-b / )Y // q7/
OWNER PROPERTY ADDRESS: SAS te•
OWNER TELEPHONE NUMBER: 1.6 - A $- 9 '7 �j
TAX MAP NO. : Section (0Z Block Lot � /
CROSS STREET: No — A
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7- 24- r'aa (® (Pu e,171...Ssin1C)
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
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Siture rApplicant
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RECEIVED BY: --/64, Ma/v . e`''
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Legend
Property or R SS'Line County Liter ®.a Fire District Line _--F_—_ H ydront District Line---F{•---_ Subdivision Lot No.
Deno`es Com O..+ter �,- Yon Line ®®® pots District Line _—.p_—_ Refuse District Li.a -....—R•-- Deed Dimension 62'
F31ALE�+>
Subdivision Let Line __—_,_, Village Line L t District Line i - -,,,
� _— ___ Bloch No. ® Scaled Dimension ,1's L�;:
Railroad -Block Limit L y '
-s--p=-1_' ��®o Park District Line _ _ Parcel No. 23 Dead Area 12A(d) • s..
Stream ,•.—_r School District Line Sewer District Line (2 ) Calculated Area 12A(c)
.� --SCH-- _—.$__ _ Subdivision Block No. 1 StIFFGSSC