HomeMy WebLinkAboutGoodwin Town Hall, 53095 Main Road
Seje, oft P.O. Box 1179
�®� ��w,�'" Southold, New York 11971
JUDITH T.TERRY '0' FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
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. 1446-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GOODWIN, JAMES D. & MARILYN H.
Mailing Address 1 P. O. BOX 1190
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 7200 DEPOT LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-7311-5679
Tax Map No. section 95.00 block 2 lot 3.000
Cross Street ROUTE 48
Date Of Last Pump Out 0/00/00
Issue Date: 4/25/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK • �FFQ (/
Town of Southold ��� ._._ eD�'- Application No. /7 ,C
Judith T. Terry, Town Clerk , 4
Town Hall, 53095 Main Road 1 :'' $10.00 - Residential
P. O. Box 1179 " , any, ?i ,
. �`�;..--:p �•:�:_�; � $25.00 - Non-Residential
Southold, New York 11971 • ® ®_ '� .*.$
TelephoneQ( ,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 10 , / / b
OWNER NAME: 3Q.4YIe S ///Q9'I•/ i'l 71), 622 Gail-) •
y
OWNER MAILING ADDRESS: - 19010)( y7Z)
A2121,40re, //925—
OWNER PROPERTY ADDRESS: -_Ian)n) Iii, - :e --1-,
csau / J ///.33
• OWNER TELEPHONE NUMBER: 73y-s4
TAX MAP NO. : Section 9s Block Lot 3
CROSS STREET: k , 7�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: NA
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.)
(19 ap•f f a
Signature of Applicant
b2,Ce
RECEIVED BY:
own Clerk's Office
DATE: A-6"/FO
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