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JUDITH T. TERRY
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax(516)765-1823
Telephone (516) 765-1800
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3728-R Residential X Non -Residential
Fee $ 10.00 New Existing X
Name Of Owner REDDINGTON, JOAN
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Mailing Address 1 98 TRUMBULL ROAD
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Mailing Address 2
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City St Zip MANHASSET NY 11030-0000
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Property Address 1 135 LILAC LANE
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Property Address 2
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City St Zip CUTCHOGUE NY 11935-0000
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Owner Telephone No. 516-627-7398
Tax Map No. section 104.00 block 1 lot 21.000
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Cross Street STERLING ROAD
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Issue Date: 11/24/97 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
OFFICE OO THE TOWN CLERK
,Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
Application No L
$10.00 - Residential
$25.00 - Non -Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ b
DATE (l l
OWNER NAME: �d A- A)
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OWNER MAILING ADDRESS: 6/p�
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER:
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TAX MAP NO.: Section Block Lot pZ,%
CROSS STREET: - -r--
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TYPE OF SYSTEM: Septic Tank v' ew Existing t/
Cesspool New Existing
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.)
' Signature of Ap icant
RECEIVED BY:
T F's Office
DATE:
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Southold T bwnn r a
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