HomeMy WebLinkAboutMeyer OFFICE OF THE TOWN CLERK
Town of Southold �� C'QG Application No.
Judith T. Terry, Town Clerk a: y
Town J-lall, 53095 Main Road o �' -< Residential
P. 0. Box 1179 u' `�® Non-Residential
Southold, New York 11971 O
Telephone!
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER'DISPOSAL DISTRICT
APPLICATION
' 'For
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •� f
DATE /
OWNER NAME: a �/ ���� K191tf
OWNER MAILING ADDRESS:
NY It
,,,,OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 4-
TAX MAP NO. : Section B'lock' ..f— Lot� " r
CROSS STREET:
TYPE OF -SYSTEM.: Septic Tank New Existing
Cesspool r�-"y New Existing
Residential-- Non-Residential
DATE -0F PREVIOUS PUMP-OUT: 4-44
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.')
Siconature of Appli n t
RECEIVED BY:
Town Clerk's Office _
DATE:
D kN s `
u'' Town Hall 53095 Main Road
fe
- P.O. Box 1179
� Southold, New York 11971
JUDITH T. TERRY 41, TELEPHONE.
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK _
TOWN OF SOUTHOLD
July 14, 1987
Evangeline A. Meyer
Nassau Point Road
Cutchogue, New Yank- 11935
I am returning your application for a Cesspool or Septic Tank
Operation Permit. Additional information is required before your
application may be processed.
Please complete the item(s) highlighted on your application.
Location Map - May be a copy of your survey with the location
of the cesspool indicated or a sketch of your
property showing the location of the build-
ings, cesspool system, approximate distance
in feet to buildings and closest road, and an
arrow indicating North.
After you have completed the requested information, please return
the application, location map and your check, which is enclosed herewith.
Thank you for your cooperation.
Very truly yours,
•
Judith T. Terry
Southold Town Clerk
Enclosures (2)
JTT/ljc
OFFICE OF THE TOWN CLERK ter '
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179 Ln
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No 367 Residential X
Fee $ 10.00
Non-Residential
-- - - --
Septic Cesspool X
NAME OF OWNER: Evangeline A. Meyer
OWNER MAILING ADDRESS: Nassau Point Road
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: Nassau Point Road
Cutchogue New York 11935
OWNER TELEPHONE NUMBER: 516-734-6528
'TAX MAP NO. : Section 111 Block g Lot 6
CROSS STREET: Carrington Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP=OUT: June 1987
Judith T. Terry
Southold Town Clerk
DATE: July 29f 1987 _
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold �® Q Application No.3�7
Judith T. Terry, Town Clerk v =.
Town J-lall, 53095 Main Road o �' ?" s "� Residential
P. O. Box 1179 v' Non-Residential
Southold, New York 11971 O y� 0.
Telephone ®,{
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
,�-
Fee $ ,�
DATE `
OWNER NAME:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: a ��
TAX MAP NO. . Section / ' Block Lot
CROSS STREET: 70 L)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential J/11- Non-Residential
- DATE OF PREVIOUS PUMP-OUT: OYA-1;� T
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.)
Sixfnature 'of ApoliQ6nt
t
RECEIVED BY:
Town Clerk's Office
DATE:
MORRIS CESSPOOL SERVICE INC. DATE
2760 Yennecott Drive
SOUTHOLD, LONG ISLAND, NY 11971 NUMBER
i
(516) 765-3300
TERMS if a receipt is requested, please send a stamped self addressed envelope.
PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $
DATE WT CH GES AND REDITS BALANCE,_
LANCE FORWARD
0
LAI
w
C�JiC�vtC?�
PAY LAST AMOUNT
IVIORRIS CESSPOOL SERVICE INC. IN THIS COLUMN
11W PRODUCT96-1