HomeMy WebLinkAboutReeve (3)JUDITH T. TERRY
TOWN CLERK
REGISTRAR 01 VITAL S fATISTICS
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
TELEPHONE
(516) 765-1801
Operation Permit No.
627-R Residential X Non -Residential
Fee $ 10.00
Septic
Cesspool X
New
Existing X
Name Of Owner
KATHRYN M. REEVE
Mailing Address 1
------------------------------
BOX 242
Mailing Address 2
------------------------------
City St Zip
------------------------------
CUTCHOGUE
NY 11935-0000
Property Address 1
--------------------
MASON DRIVE
-- ----------
Property Address 2
------------------------------
City St Zip
------------------------------
CUTCHOGUE
NY 11935-0000
Owner Telephone No.
--------------------
516-734-5138
-- ----------
Tax Map No. section
------------
104.00 block 7
lot 6
Cross Street
BROADWATERS ROAD
Date Of Last Pump Out
------------------------------
0/00/00
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Issue Date: 2/26/88 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
OFFICE OF 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
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
Application No.�
Residential
Non -Residential
DATE
OWNER NAME:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: '� 3
TAX MAP NO.: Section % Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing X
Residential �(e Non -Residential
DATE OF PREVIOUS PUMP -OUT: ? �-� ae:
LOCATION MAP: Must be attached hereto before permit may be iss ed.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
Signat 0
a of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
It