HomeMy WebLinkAboutSharp •
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Town Hall, 53095 Main Road
�® /r P.O. Box 1179
---- I ilit •` •... Southold, New York 11971
JUDITH T.TERRY -.,,,,,,,,00' TELEPHONE
TOWN CLERK (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. 712-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SHARP, DEVORA
Mailing Address 1 P.O. BOX 230
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 NASSAU POINT ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6397
Tax Map No. section 111. 00 block 8 lot 1. 000
Cross Street OLD MENHADDEN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 5/24/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i . .i,
OFFICE OF THE TOWN CLERK c�VFFO(,r.
Town of Southold �� " CQG Application No. 7/).
Judith T. Terry, Town Clerk Residential R/
Town Hall, 53095 Main Road 8 Ay t. t�3i -
p. O. Box 1179y' YF ' � Non-Residential
Southold, New York 11971 *071.--
Telephone !
•
(516) 765-1801 1
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 7 /c2.,
Fee $ / 7) 00
DATE ,S12-(f/41'.
OWNER NAME: OF ✓vILA S11-, r
OWNER MAILING ADDRESS: fr 0, 8oX
-L'i, ,'J I' 1 /5
OWNER PROPERTY ADDRESS: -SSS, v FT, got
(, G�d���, /v'• Y. // Y35
OWNER TELEPHONE NUMBER: 676 - 73 f- 6 3 %1
TAX MAP NO. : Section I'll Block Lot
CROSS STREET: 04,0 t e ��,v' 4!
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing L�
Residential 1/- Non-Residential
DATE OF PREVIOUS PUMP-OUT: //er
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 Applica
RECEIVED BY: ..%6/�,
o C -r • fice
DATE: 4/44
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