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JUDITH T. TERRY ; Town Hall, 53095 Main Road
TOWN CLERK ® T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS • �� Southold, New York 11971
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MARRIAGE OFFICER Fax (516) 765-1823
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2059-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SCOTT, JOHN AND SANDRA
Mailing Address 1 P. O. BOX 1168 -
Mailing Address 2 MAIN ROAD
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6278
Tax Map No. section 102.00 block 2 lot 23.000
Cross Street COX LANE
Date Of Last Pump Out 0/00/00
Issue Date: 2/25/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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