HomeMy WebLinkAboutSearl -
oilerk vier
04- Ct4
Town Hall, 53095 Main Road
P.O. Box 1179
_® ®�e Southold, New York 11971
JUDITH T.TERRY 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. 1167-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SEARL, STANFORD J.
Mailing Address 1 SEARL, PARNEL WICKHAM
Mailing Address 2 P. O. BOX 999
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 NEW SUFFOLK ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6250
Tax Map No. section 110.00 block 8 lot 33.000
Cross Street WICKS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/22/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
II-
OFFICE OF THE TOWN `CL"ER`IC •���F�(�."
Town of Southold - Application No. //t' 7
Judith T. Terry, Town Clerk .` t?
Town Hall, 53095 Main Road ..4 -� $10.00 - Residential z/
P. O. Box- 1179
cry = M ,, ` $25.00 - Non-Residential
. .. ��
Southold, New York 11971 Off® 0�•,`,
Telephone
�►�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1/6, 7
Fee $ /Ie
DATE Z'Oa 1911( i
OWNER NAME: SrAit)P-tlRZ �, °�- /U6--L Ole/04/ W S 74 L
OWNER MAILING ADDRESS: . C , ?d )( 9 q
CUTtWOGU� ? A mac
OWNER PROPERTY ADDRESS: lUSU PPd L(aC
O G U J How-
OWNER TELEPHONE NUMBER: /6 - 72(1--(.0 S' a
TAX MAP NO. : Section /JO Block g Lot 3
CROSS STREET: !',J/CHCS -
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V • New Existing 4/
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: iq
LOCATION MAP: Must be attached hereto before permitmay be issued. _ _
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
Canthfiru-Zde —,i2,
Signature of Applicant
RECEIVED BY: • , ,
Town Clerk's Office
DATE:
JUN H 1969
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