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JUDITH T. TERRY tTown Hall, 53095 Main Road
TOWN CLERK •
® P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS =
MARRIAGE OFFICER V,® ����
. �� Fax (516) 765-1823
® ' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ® .
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3226-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner RAMSEY, VAUGHAN
Mailing Address 1 P. O.BOX 670
Mailing Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Property Address 1 225 OAK ROAD
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-734-6815
Tax Map No. section 110.00 block 8 lot 10.000
Cross Street GRATHWOHL ROAD
Issue Date: 7/21/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I Ilii _
OFFICE OF THE TOWN CLERK rc3IFO(,r
Tcom of Southold •:y 10 CQ/' Application No. 3c1
Judith LT. Terry, Town Clerk �` a� v1
Town Hall, 53095 Main Road # � :' $10.00 - Residential% ,✓
P. O. Box 1179 '.„ . , ` $25.00 - Non-Residential
Southold, New York 11971 O ® i1C
Telephone : l �1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ (b,o®
DATE ?
OWNER NAME: VAUGHAN RAMSEY
PO BOX 670
OWNER MAILING ADDRESS:! NEW SUFFOLK NY 11956-0670
OWNER PROPERTY ADDRESS: 225 Oak ,`
New Suffolk. NY 11956
OWNER TELEPHONE NUMBER: 734--- 6815
TAX MAP NO. : Section / / 0 Block ? Lot Lb
CROSS STREET: • - - ,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing V
Residential / Non-Residential
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.)
Pe1.444,S
Signature of Applicant
RECEIVED BY: -
wn lerk's Office
DATE: 0--6
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S
Mr.Vaughan Ramsey
225 Oak Rd
New Suffolk, NY 11956
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