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JUDITH T. TERRY � O Town Hall, 53095 Main Road
TOWN CLERK ® T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER � � Fax (516) 765-1823
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3031-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner FITZGERALD, JAMES E. JR.
Mailing Address 1 P. O. BOX 791
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 385 HAYWATERS DRIVE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7424
Tax Map No. section 1Q4.00 block 5 lot 25.000
Cross Street OAK DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 5/21/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFI.CE'OF THE TOWN CLERK 'c�OFD(A'."`
Town of Southold �� CQG' , Application Noe:-.2b3/7 -
Judith T. Terry, Town Clerk % i ; , a=� y
Town Hall, 53095 Main Road v '' , $10.00 - Residential
P. O. Box 1179 v' k ,es h�i ` $25.00 - Non-Residential
Southold, New York 11971 %O`Ow.ji �����,'` _
Telephone : ,( '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10.00
DATE May 18, 1993
OWNER NAME: James E. Fitzgerald, Jr.
OWNER MAILING ADDRESS: PO Box 791
Cutchogue, NY 11935
OWNER PROPERTY ADDRESS: 385 Haywaters Drive
Cutchogue, NY 11935
OWNER TELEPHONE NUMBER: 734-7424
TAX MAP NO. : Section 104 Block 5 Lot 25
CROSS STREET: Oak Drive
TYPE OF SYSTEM: Septic Tank New Existing X
Cesspool New Existing X,
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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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Signature o,;ppli • t /
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RECEIVED BY: = -_ - - — -- ----
Town Clerk's Office
DATE:
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