HomeMy WebLinkAboutSuter 010-1101 ,
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Town Hall, 53095 Main Road
0'2 ,N44' l P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY -; 3� ,��� 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. 813-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner SUTER, PAUL & VIRGINIA
Mailing Address 1 BOX 67
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 BEACHWOOD ROAD,
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6783
Tax Map No. section 116. 00 block 4 lot 22. 000
Cross Street PRIVATE ROAD
Date Of Last Pump Out 7/18/85
Issue Date: 9/06/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
SI
OI:FICE OF THE TOWN CLERK
Town of Southold �� C'Q � , Application No. /,3
Judith T. Terry, Town Clerk A.P,( r y
Town Hall, 53095 Main RoadResidential
P. 0. Box 1179 v' -` 51A4j: Non-Residential
Southold, New York 119710�•'`��
Telephone Q( `N� '..
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
0PERAT ION'PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /b%
DATE 77/1
OWNER NAME: r- rcrc
OWNER MAILING ADDRESS: 1,- '7
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OWNER PROPERTY ADDRESS: 644....„4„......4 / )
OWNER. TELEPHONE NUMBER: ?3v
TAX MAP NO. : Section //4 Block f Lot c2
CROSS STREET: 12/d.,-, lea
TYPE OF SYSTEM: Septic .Tank New Existing
Cesspo• NewAMP
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: P Ao`1ir
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 Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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