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Home My WebLink AboutFox CtLiar 0 JUDITH T. TERRY :I Town Hall, 53095 Main Road TOWN CLERK 2E t P.O. BOX 1179 REGISTRAR OF VITAL STATISTICSG �` Southold, New York 11971 cam, C) fr Fax (516) 765-1823 MARRIAGE OFFICER � / �'.ii " 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. 1982-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner FOX, DANA Mailing Address 1 305 PRIVATE ROAD Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 305 PRIVATE ROAD Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-5349 Tax Map No. section 114.00 block 7 lot 2.002 Cross Street WESTPHALIA ROAD Date Of Last Pump Out 0/00/00 Issue Date: 10/02/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) cv we,4,1.0 cz,s, JUDITH'. TERRY a Town Hall, 53095 Main Road TOWN CLERK ® totP.O. Box 1179 REGISTRAR OF VITAL STATISTICS :A 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. 1982-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner FOX, DANA Mailing Address 1 305 PRIVATE ROAD Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 305 PRIVATE ROAD Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-5349 Tax Map No. section 1 .14 block 7 lot 202 Cross Street WESTPHALIA ROAD Date Of Last Pump Out 0/00/00 Issue Date: 10/02/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) R OFCE OF THEE TOWN CLERK O •5 F't1F0C,r�'- , To n of Southold � CQ ' Application No. /9,a_ Judith T Terry, Town Clerk .� m s '- 1 $10.00 - Residential Town Hall, 53095 Main Road P. `O. Box 1179 v' ��: �� h�i ; $25.00 - Non-Residential Southold, New York 11971O „® �Z' -�$ Telephone '0/ (516) 765-1801 TOWN OF; SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE 9A/2_, OWNER NAME: >-)94V/16)( OWNER MAILING ADDRESS: ,36s /jtHT ,Pv - ,x777 Z.JGLr A-4/ // 9 S� OWNER PROPERTY ADDRESS: S � OWNER TELEPHONE NUMBER: o??? 5-3 c' 9 TAX MAP NO. : Section/a /74L Block 7 Lot CROSS STREET: G(J�S7 '9L./4 D. TYPE=OFSYSTEM: SepficTank - ` - New Existing Cesspool New Existing Residential Non-Residential 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.) w4 ignature of Ap.licant RECEIVED13Y: _ . . -._. . , - - Town Clerk's Office DATE: /d fL. - - - - v Pail POP toe,c) // L/ ik-41-1-700-P7-41 /46S)445 Lit------ i3z..i? 7 ±°'crr 71-",."../ ..,J \.,.,-'r. L...-,1.-) 1 •, !......:_ .-- Ny R.Ata e' LOT .1-2.-- _ ' d€, - 1 /T. ,_-----.....Ths....,, :_.,..,....., . (T . >,-, --------;-----,JA,, 1.- ii2" Z. ..:0 / '-fAiRk• I .11i.510 ID 1 ;IL Z0(,- _------------ •W . . , . . . - -.... ....- .--- .....--....."*.=-7::-...., ,, . • . , ._ . _ . • - —---- ;k • / / - • • . f,../ •••,._...... , \. - . , • _cr ., IV -•\/' •-- • • .....' ,.. . . • • • .• , • '-, , • WES IQ • -1.0 • .1 . ...TZ 0 •i / -X v•?\/ i. :--,- , „.• , - .§- - - 41v... 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