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JUDITH T. TERRY ;, '4 . Town Hall, 53095 Main Road
TOWN CLERK v ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ��
Southold, New York 11971
MARRIAGE OFFICER yQ O�' , Fax (516) 765-1823
Al 1.
, Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3136-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New - Existing X
Name Of Owner PARKER, ROBERT E.
Mailing Address 1 P. O.BOX 1568
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 15845 COUNTY ROUTE 48
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7027
Tax Map No. section 101 .00 block 1 lot 13.000
Cross Street ALVAH'S LANE
Date Of Last Pump Out 0/00/00
Issue Date: 10/26/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK si _
Town of Southold 4 3 ,�
� ;�-� � Application No. f
Judith PT. Terry, Town "Clerk' ;"� _ • !/
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 cry ' • $25.00 - Non-Residential
Southold, New York 11971 Oer ��•,
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Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLI CAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE i� //(f
OWNER NAME: .Ro,I e/-T ca-r/f-ff/' •
OWNER MAILING ADDRESS: x 6 ox f s
1)2a- .mac k- ft y // 93-
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OWNER PROPERTY ADDRESS: � f -
sem; _ �/ r ! •
OWNER TELEPHONE NUMBER: 73C-1--- 7(0 7
TAX MAP NO. : Section/ ) o / Block ( Lot f _..7
CROSS STREET: PLL-V - 1
• 'TYPE OF SYSTEM: Septic Tank New Existing
Cesspool k- New Existing
Residential _ Non-Residential
DATE OF PREVIOUS PUMP-OUT:
LOCATION MAP: Must be attached heretkfjtefore permit may be issued.
(Locate building and sys:t'em; give north arrow and feet
of distance, approximately;-to -building 'and closest road.)
Signature of Applicant
;RECEIVED BY: , (�
X'k I own Clerk's Office
DATE: /fes / 93
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TOWN OF SOL/THOLD
SUFFOLK CO., N. Y.
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T/COR TITLE GUARANTEE
ROO/ - -.--CONC. V , Li (T/287-2/431' ,
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-i9 a I,��, 4i SUSAN EGAN
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O.5'E ' OVRNG L 580 47' Q 0 west main street
, S 6/°/3'/5,"W 64.7. 1'6rriverhead, new york 11901
PEEC'REE (516) 369-1717
1111/D®L E - ROAD
May 27, 1987 Job N2 87-1742
(a/so.' NORTIrROAD, C. R. 48) i 1000-101-01-13 Scale: I"= 30'
AREA; 246/4 S F, (0.4962'.A'C.J;•