HomeMy WebLinkAboutRosie's Old Mill Inn I , • ...y.
40,°111X474
* Town Hall, 53095 Main Road
�+® � ` P.O. Box 1179
-----.."0 'Poor Southold, New York 11971
JUDITH T.TERRY „,,r��� 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. 68-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New X Existing
Name Of Owner ROSIE' S OLD MILL INN
Mailing Address 1 P.O. BOX 998
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 MILL ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8979
Tax Map No. section 106. 00 block 6 lot 4. 000
Cross Street - NAUGLES ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 5/17/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
tOFFICE OF THE TOWN CLERK sCVV.F0"
Town of Southold �% . CD _�.----Application No. 6 s
Judith T. Terry, Town Clerk x4
Town Hall, 53095 Main Road ~ :. ''c Residential
P. O. Box 1179r. , - ► Non-Residential ?( ,
Southold, New York 11971 O ® ti.,, ,. .$
Telephone */*--- 0'.•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.j 2 G it
Fee $ `O
DATE 11 1111
OWNER NAME: VOGits OLS JLUJ t
OWNER MAILING ADDRESS: PO cng
tAAf-(rfOC , 134 1.1,9S2-
OWNER
.i.cIs2OWNER PROPERTY ADDRESS: UP of Ala, e-P,
m, .va r 03 Vl Vii C 2_
OWNER TELEPHONE NUMBER: 5110 2_9 % gl" q -
TAX MAP NO. : Section I O( Block & Lot t(d
CROSS STREET: 13ArvA....'.5
TYPE OF SYSTEM: Septic Tank X New Existing
Cesspool / New Existing -
Residential Non-Residential X
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.) •
ON r Ls. w/ -roam A : ," ., il v i i c),., ypeora
0t ��
N9
_....
iwn.ture of Appli%nt
RECEIVED BY ; %,.,_-,;,,�, _, 0 „ •
,own Cfrk's Of ice
DATE: MAY 111988 = - - _- -
Town Clerk-Southall -
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