HomeMy WebLinkAboutRoss OFFICE OF THE TOWN CLERK cs\VFX]
Town of Southold
Judith T. Terry, Town Clerk , t�
Town Hall, 53095 Main Road
P. O. Box 1179 ', ‘=3' < . ;t
Southold, New York 11971
Telephone __U1 '7`�'�
(516) 765-1801 ffF-
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR54 Residential
Fee $ 25.00 Non-Residential x
Septic Cesspool x
NAME OF OWNER: John C. Ross - Ross' North Fork Restaurant
OWNER MAILING ADDRESS: Box 560 •
Southold, New York 11971
OWNER PROPERTY ADDRESS: 44780 Middle Road (C.R. 48)
Southold, New York
OWNER TELEPHONE NUMBER: 516-765-2111
TAX MAP NO. : Section 63 Block 1 Lot 24
CROSS STREET: Youngs Avenue
•
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: Oct. 1987 ,
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Judith T. Teery
Southold Town Clerk •
DATE: December 8, 1987
•
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK .C3��FOU �'-
Town of Southold �R.�/
ff _:401--.4 ).-('.4'` Application No. /
Judith T. Terry, Town Clerk . 'EVA . .
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Town Hall, 53095 Main Road a :•
.•G Residential
P. -O. Box 1179 GJ7 � Oa*r � `
Non-Residential
Southold, New York 11971 O -_0� ••
Telephone 1 y►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. N/Z v /
Fee $ ao
DATE /2/7 0 7
OWNER NAME: -TC)HN c. /`4-ff
OWNER MAILING ADDRESS: 09..`' 5d sod/J o4 11,X
OWNER PROPERTY ADDRESS: Ira 7M,,OW An. ("7 .11.-- ` tf)
OWNER TELEPHONE NUMBER: 76: 2-Ill
y TAX MAP NO. : Section D 3 Block 1 Lot P2/
CROSS STREET: .Wit/c AV&
TYPE OF SYSTEM: Septic Tank New Existing /
Cesspool / New Existing ‘/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: OG r- f-
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.)
II"
4 �.na ure of Applicant
RECEIVED BY: ii „ / __,
own i%lerk's 4 ffice
R EC I VED
DATE:
DEC 07'1987
Tnrvn Clerk Southold -
9
J NORTH FORK
RESTAURANT
MAIN ROAD, SOUTHOLD, NEW YORK 11971 516 765-2111
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