HomeMy WebLinkAboutMiller •
OFFICE OF THE TOWN CLERK � OC, ,.
Town of Southold4
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971 ‘4F1
Telephone 7201 *
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK- or CESSPOOL
Operation. Permit No. 534 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool x
NAME OF OWNER: Genevieve Miller
OWNER MAILING ADDRESS: 450 Bay Road
Cutchogue, New York 11935
OWNER PROPERTY ADDRESS: 450 Bay Road
Cutchogue, New YOrk
OWNER TELEPHONE NUMBER: 516-734-5263
TAX MAP NO. : Section 116 Block 2 Lot 18 •
CROSS STREET: Case Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: November 25•, 1985
Judith
Southold Town Clerk
DATE: December 14, 1987
1
(TOWN SEAL) )
„I
OFFICE OF THE TOWN CLERK c WFU(/r•,.-
Town of Southold CQ� Application No. ur 3 ffJ
Judith T. Terry, Town Clerk . hz
Town Hall, 53095 Main Road c .4 :`� Residential
P. O. Box 1179 Non-Residential
Southold, New York 11971 *”
Telephone Se7: �! 1
•
(516) 765-1801 •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $10(c)
DAT-EDcceYnIL) r 101 ) c???.
OWNER NAME: eI'1C V IC.V
OWNER MAILING ADDRESS: yS O 2)/j loAL
C^'u (k& J\1• Y. iI13s-
.}
OWNER PROPERTY ADDRESS: Q ho�y
OWNER TELEPHONE NUMBER: 73 q - -.6;2 Lj
TAX MAP NO. : Section i 1 te, Block o2 Lot \R
CROSS STREET: Sc� o�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool L.Z. New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: II )3frl
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.)
&IOW (.1 h/)
Signature of Applicant
RECEIVED BY: . 1to,
RE:_ .*T' rown Clerk 's �Ofe
DATE: DEC 14 t'`-•.`7
Town Clark Southold
' SO ULA\Th
-5' `'_i
GENEVIEVE C MILLER
450 BAY ROAD
' CUTCHOGUE NY 11935
(I!: h
n
: P
ss_Fc_es--)4-- k ' G31..a!(,-,:t4.?.14_
0 c k