HomeMy WebLinkAboutRobedee OFFICE OF THE TOWN CLERK $ cOFULA'
Town of Southold 0,4_
Judith T. Terry, Town Clerk jr yr
Town Hall, 53095 Main Road o >_
P. 0. Box 1179 i, Mk t '�
Southold, New York 11971 ® ..
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 495 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: Edward Robedee
OWNER MAILING ADDRESS: Rt 1 . 1935 Pine Tree Road
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 1935 Pine Tree Road
Cutchogue, New York 11935
OWNER TELEPHONE NUMBER: 516-734-5488
TAX MAP NO. : Section 98 Block 1 Lot 11 . 1
CROSS STREET: Redwood Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: unknown
o
{ Judith T. Terry
Southold Town Clerk
DATE: Novmeber 24, 1987
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c3\\FFO( (C
' Town of Southold _, Application No.'/7
\ Judith T. Terry, Town Clerk /
sG
Town Hall, 53095 Main Road Residential
c ' � -
P. O. Box 1179 cc?, .+` - ` Non-Residential
-Southold New York 11971 O __`
-\ Telephone d5f'ol
0
d (516) .765-1801
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4'95
Fee $ /6 - 60
DATE // 7/ 74 7
OWNER NAME: %/ tg12 !v
OWNER MAILING ADDRESS: /al / / 9'36" f/ 'J- /ZJ) -
G v rG/o 1 ,AJ7 // r 3
OWNER PROPERTY ADDRESS: %L S 4,8 1 t/ 4
OWNER TELEPHONE NUMBER: 7 �rcc— C 4
TAX MAP NO. : Section ?e? Block / Lot //,
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool r/ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: I)d7"/('4/ 14/ Ar-771-Al /a 4/1 7
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.)
Sign ure of Applicant
o pp �
RECEIVED BY: Ge.�f1rt
RECEVE own(,Clerk's ffice
DATE: Nov 24 9g7
nen+n C brk Southold
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