HomeMy WebLinkAboutSouthold Yacht Club ® Fav l�+
g53 Town Hall, 53095 Main Road
.4 P.O. Box 1179
y� 4\--4� Southold, New York 11971
JUDITH T.TERRY , ��/ ���l1I FAX(516)765-1823
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. 101-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner SOUTHOLD YACHT CLUB
Mailing Address 1 P. O. BOX 546
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 NORTH PARISH DRIVE
Property Address 2`
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 71 .00 block 1 lot 3.000
Cross Street NORTH BAYVIEW ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 1/29/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFIL E OF THE TOWN CLERKS\\FFD(,sr
Town of Southold ��.. Application No.
Judith T. Terry, Town Clerk . -444
Town Hall, 53095 Main Road ,% .4k, $10.00 — Residential
P. O. Box 1179 (fl k x� i
$25.00 - Non-Residential
Southold, New York 11971 %O '® `??'.
Telephone •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
•
DATE d! //0���
OWNER NAME: f9v-7-1410/._•N & c-ir C-�/a •
OWNER MAILING ADDRESS: I 0, 8,9,
jov-r t_z Y 1!
OWNER PROPERTY ADDRESS: 11OLTfd exliu411 f ply.P-
J-7-1J101_A ,y 17/
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section `71 Block 1 Lot 3
CROSS STREET: N PI6LIAA Dal re, + V• ���ll�dP�,✓
TYPE OF SYSTEM: Septic Tank 'S New Existing )61
Cesspool 74 New Existing
Residential Non-Residential )`
DATE OF PREVIOUS PUMP-OUT: Play a
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.)
�l
Sign.`
ie of Applican
RECEIVED BY:
Town Clerk's Office
DATE:
I
JI
' 5. 14•05'lC)"\V. - 34c .o
j .-‘
I
Y -
'� . /.0.) ,
�- a I - `
4
NI
N , .
A. r® 1
%? k
f - I
/di a__ 1 , „
4.
4 / tn --1- 4_,'-_,:. ....0.5 / \\ SC,
`f'
, --------------„,,Z. 1 v
C ,
4G - 4
/ - t4 _`_
t'• UTILITY S&R1/IGE '- —
I
i I .1T LI cV E yr - - -— - - -- — -
--ter -rc..- g�
N. l'4•C)! ' IA' e. --- --- �-r1/4-c-- 415.0 Fsr -)Gf: O pnvr'AL►-tT .
race o t'�vtx�ti T
Towns or- sc)U T:•1o1-,n