HomeMy WebLinkAboutNorth Fork Country Club tl r
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Town Hall, 53095 Main Road
�� P.O. Box 1179
_ �j � e Southold, New York 11971
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JUDITH T.TERRY �� FAX(516)765-1823
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TOWN CLERK TELEPHONE(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. 92-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner NORTH FORK COUNTRY CLUB
Mailing Address 1 P. O. BOX 725
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 25650 ROUTE 25
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6338
Tax Map No. section 109.00 block 4 lot 7.001
Cross Street LINDEN AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 7/06/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK � � �'-
Town of Southold Q� .F-�,`'. 7�
Q ' Application No.472
Judith T. Terry, Town Clerk : ' � `? %4 1'� - Residential
Town Hall, 53095 Main Road 8 „ 4} $10.00
P. O. Box 1179 11-3 -k.% e,.
� � j1_. z. z 25.00 - Non-Residential !�
Southold, New York 11971 O =® r,,.! -�
Telephone :u't 411
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(516) 765-1801 0 ,l /oov,
TOWN O,F SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
_for'
- OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 25 .00
DATE July 6, 1989
'OWNER NAME: North Fork Country Club
OWNER MAILING ADDRESS: P.O. Box 725
Cutchog»P, N.Y. 11935
OWNER PROPERTY ADDRESS:
Cutchog'w-, N Y 1 1 q3q
OWNER TELEPHONE NUMBER: ( 516) 734-6338
TAX MAP NO. : Section 109 Block 4 Lot 7 .1
CROSS STREET: r.inaPn AVP.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool XX New XX Existing
Residential Non-Residential XX
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.) 7
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Signature of Applicant r'
RECEIVED BY:
4.- a ” Clerk's Office
DATE: JUL 51989
Ifno Clerk Southold
Sr
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