HomeMy WebLinkAboutGlover JUDITH T.TERRY � � .4� Town Hall, 53095 Main Road
TOWN CLERK 4 P.O. Box 1179
P Southold,New York 11971
REGISTRAR OF VITAL STATISTICS � '-.`• Is Fax(516) 765-1823
MARRIAGE OFFICER , " ®� �
RECORDS MANAGEMENT OFFICER I *tool' Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3697-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner CLOVER, EVERETT AND DOROTHY
Mailing Address 1 1145 STILLWATER AVENUE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1145 STILLWATER AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5575
Tax Map No. section 103.00 block 1 lot 16.000
Cross Street WILLOW STREET
Issue Date: 10/07/97 Judith T. Terry
Southold Town Clerk
•
(TOWN SEAL)
OFFICE .PF TiHE TOWN CLERK c3�FFU(i(rCQG° 1�7
Town &f Southold �� Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 v' - ► z $25.00 - Non-Residential
Southold, New York 11971 O ' ' *.$
Telephone Jire
fie!-.•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ Qdo
• DATE `1 1 q9
OWNER NAME: 1P � C9�C� 4LCO&R._
OWNER MAILING ADDRESS: _
C /3_
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 1,3 --
TAX MAP NO. : Section `6 3 Block / Lot l
CROSS STREET: W1 W ` ;r
TYPE OF SYSTEM: Septic Tank New Existing X
Cesspool New Existing X
Residential Non-Residential
LOC_ATION 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.)
QIN , ,119.4,
Signal a Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
11
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