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Home My WebLink AboutRodgers j4/'/I'I/I• "i `fir i ` Town Hall, 53095 Main Road V® /�, P.O. Box 1179 <Sr i•• Southold, New York 11971 JUDITH _- r�`„�� FAX(516)765-1823 T.TERRY �� 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. 1146-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner RODGERS, EDWIN H. Mailing Address 1 P. O. BOX 825 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 OLD SALT LANE Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-4634 Tax Map No. section 144.00 block 5 lot 21.000 Cross Street SAILOR'S NEEDLE ROAD Date Of Last Pump Out 0/00/00 Issue Date: 6/13/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) • OFFICE OF THE TOWN CLERK �5s1fFU(,1r�'- • Town of Southold © C'� Application No. //V,6, Judith T. Terry, Town Clerk � ��.�-*,-Z%1%i $10.00 - Residential Town Hall, 53095 Main Road _ �sr '� p. 0. Box 1179gig*. . $25.00 - Non-Residential Southold, New York 11971 O ;® xe�. ,t 1 Telephone ®j y `et �� (516) 765-1801 'TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 493 R Fee $ / O' DATE JU %tl . 10 "' /grl 'OWNER NAME: / lJ tiv t N H, Ro C OWNER MAILING ADDRESS: / 3 0 X fY( WA-if/ Kr& i IVY, 11611-1/ OWNER PROPERTY ADDRESS : f7 c f/t1 - A,RA: !1 a A.17 OWNER TELEPHONE NUMBER: TAX MAP NO. : Section / 424'-`'° Block ,' Lot : ./, `94".1 CROSS STREET: )8a uv� TYPE OF SYSTEM: Septic Tank New Existing Cesspool __A. - • istin Residentia Non-Residential DATE OF PREVIOUS PUMP-OUT: 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: 1 VWown Clerk's Office DATE: JUN 13 19 9 VR�U�%✓wi.� . m t a. Z n 9 3 Ati.URQn, 4'