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HomeMy WebLinkAboutMeyer OFFICE OF THE TOWN CLERK c.31FD(ir1' Town of Southold �� CQ � Application No. Judith T. Terry, Town Clerk 1 'fr, _j .y Town _Hall, 53095 Main Road o f'7,42,•07 ,k -'� Residential P. O. Box 1179 tr2 7 � Non-Residential Southold, New York 11971 O ® Telephone 1 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER'DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT 'SEPTIC TANK or CESSPOOL • Operation Permit No. Fee $ n •%T- / DATE A71(.1 d ') r • OWNER NAME: rt) / )Z/ 1 09/(I 4, f OWNER MAILING ADDRESS: J, ,j5I7U f W:7 ,4,/ G OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: /_3)7 c/ TAX MAP NO. : Section 1/) C1 Block' Lot, CROSS ITREET: TYPE OF SYSTEM,: Septic Tank New Existing Cesspool -' New Existing Residential Y - Non-Residential -DATE OF PREVIOUS PUMP-OUT: fi 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: - -, arc==s.. EVANGELINE A. MEYER 1 5 - NASSAU POINT CUTCHOGUE, N.Y. 11935 1g 50-791/214 I` © G - PAY TO THE � / I $/O ORDER OF • �_DOXLARS ➢ i Aar _02- vie NOVO THIO BANK&TRUST Ca SOUTHOLD,L I,N Y 11971• .40 MEMO r 1_n a Lon 79 L 21: 0 3 i" 3 L 20 d3II' 50 31.1 c=2fcFe a ,moi • • cr3 f:'% 'law -.� Town Hall 53095 Main Road � „ it• � ��� P.O. Box 1179 . y®1 )\1a �� Southold, New York 11971 JUDITH T. TERRY ���..,.>i i���••I 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 �� 7' -dOrt Town of Southold .S •'"'''-� , Judith T. Terry, Town Clerk Z �41 , Town Hall, 53095 Main Road a A, .gt i M P. 0. Box 1179 ` v' -��� . Y ,' w Southold, New York 11971 7M,�y� rt ,,L -'��- Telephone -- ( r �` (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 367 Residential X Non-Residential Fee $ 10.00 Septic Cesspool x NAME OF OWNER: Evangeline A. Meyer OWNER MAILING ADDRESS: Nassau Point Road Cutchoque, New York 11935 OWNER PROPERTY ADDRESS: Nassau Point Road Cutchoque, New Yo rk 11935 OWNER TELEPHONE NUMBER: 516-734-6528 TAX MAP NO. : Section 111 Block 8 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 29, 1987 ' _ (TOWN SEAL) +, rJr OFFICE OF THE TOWN CLERK �o Town of Southold ® C'Gpp 3t D A lication No. Judith T. Terry, Town Clerk _... �7 Residential Town J-lall, 53095 Main Road o s P. O. Box 1179 v' - ' i�� Non-Residential Southold, New York 11971 O (Zit- ,* $ Telephone '41°/- 51 0 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION dV! , OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $/f - . // DATE /` OWNER NAME: 1Q ) E (1/9AI G /,lam - . ) OWNER MAILING ADDRESS: J, �� w °r(ieP"4/ OWNER PROPERTY ADDRESS: � -.,F� OWNER TELEPHONE NUMBER: /.3'k,(4 TAX MAP NO. : Sectioni Block Lot/ CROSS STREET: 6/a'et(,t) G-roA.) 4),jj TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential V Non-Residential - DATE OF PREVIOUS PUMP-OUT: ajt,,1,1}0,/p7 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.) 2 ,f Signature 'of ApOIicAnt RECEIVED BY: Town Clerk's Office DATE: -nr; k MORRIS CESSPOOL SERVICE INC. /DATE 2760 Yennecott Drive SOUTHOLD, LONG ISLAND, NY 11971 NUMBER \ J (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 7 " BALANCE,_ 7 i ` 1—' •LANCE FORWARD iv 0 Ili, COW G PER f Ortant PAY LAST AMOUNT MORRIS CESSPOOL SERVICE INC. e I IN THIS COLUMN 11W PRODUCT 96-1