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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