HomeMy WebLinkAboutGoldhush �,� FO
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ELIZABETH A.NEVILLE I;`t° �y Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �,1 Fax(516) 765-1823
MARRIAGE OFFICER �- ® '�� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER � �®� • l
FREEDOM OF INFORMATION OFFICER ���i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3787-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner GOLDHUSH, ALVIN
Mailing Address 1 P. O. BOX 950
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1800 LITTLE PECONIC BAY ROAD
Property Address 2
City St Zip CUTCHOGUE NY 19135-0000
Owner Telephone No. 516-734-6710
Tax Map No. section 111 .00 block 14 lot 20.000
Cross Street WUNNEWETA ROAD
Issue Date: 5/11/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
, ��I
0.4--10E OF THE TOWN CLERK �CIIf FOL4- :'
H
TOWN QFSOUTHOLD , COG Application No. .37
. ELIZABETH i NEVILLE,TOWN CLERK ' :, ., `�• I $10.00 - Residential
P.O.BOX 1179 � ' `
SOUTHOLD,NEW YORK 11971 4='" 4,.:.,'Z: �,� $25.00 - Non-Residential
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Telephone - l '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT -
APPLICATION
for
OPERATION PERMIT
. SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
. DATE Lff
OWNER NAME: AL V/0 O i-v „SW
OWNER MAILING ADDRESS: P'. 6) .- cO 't< 9_S0
L / c> C-7f Al Gj. //93,5—
OWNER
3SOWNER PROPERTY ADDRESS:- /C 0 ) 4/777&"-- / lV/tJ%C 4, (e(
c)G0&— N y .//93S—
OWNER TELEPHONE NUMBER: 73c ea 7/-®
y TAX MAP NO. : Section //7 Block / Lot ` 2L2,. ag6
CROSS STREET: /,U0/j,//J/EGfJ %4 N' p
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool Gr"- New Existing ✓
Residential I,,/ Non-Residential ' V
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.)
1/
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Si. ature of Applicant .
RECEIVED BY: , LUL-e:- .1:C.-L-2�
T wn Clerk's Office
DATE: �f,�
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