HomeMy WebLinkAboutFraser (2) -11417010.1.0 et•
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Town Hall, 53095 Main Road
P.O. Box 1179
e740 Southold, New York 11971
JUDITH T.TERRY
�� FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 1423-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner FRASER, CHARLES
Mailing Address 1 7325 NASSAU POINT ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 7325 NASSAU POINT ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6020
Tax Map No. section 118.00 block 4 lot 1 .000
Cross Street BRIDGE LANE
Date Of Last Pump Out 0/00/84
Issue Date: 3/19/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
+ t
OFFICEa..
OF THE TOWN CLERK ' FF°(,r
Town of Southold o _. CQ Application No. !'¢c2,3
Judith T. Terry, Town Clerk . y
x»t a $10.00 - Residential
Town Hall, 53095 Main Road
P. O. Box 1179 t14 $25.00 - Non-Residential
Southold, New York 11971 O,� Ml®_
TelephoneOI
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
•
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 03//.61q0
OWNER NAME: C t •
•
OWNER MAILING ADDRESS: 7� ,� yla.ssc.cit_. Po0nj- koa49,...
o.uTCk_c)GO e , ��a `/a 1161 -6S
OWNER PROPERTY ADDRESS: '7 3g.5 aGLS /Pot r --- R0
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OWNER TELEPHONE NUMBER: 5/6
TAX MAP NO. : Section B ( ' Block 4 Lot
CROSS STREET: iSIiSSi i-L. Po;NIT- ama, p E LR-1\)E
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /� 4
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.)
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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