HomeMy WebLinkAboutMott (2) 111 /cAWFDL
?` '��� Town Hall, 53095 Main Road
�1 P.O. Box 1179
-__Vo iic •1/ Southold, New York 11971
JUDITH T. TERRY �����������/,l/ 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. 1078-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MOTT, S. OVERTON AND ANOTHER
Mailing Address 1 P. O. BOX 104
Mailing Address 2
City St Zip GILBERTSVILLE NY 11376-0000
Property Address 1 1400 CALVES NECK ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3908
Tax Map No. section 63.00 block 7 lot 26.000
Cross Street MID FARM ROAD
Date Of Last Pump Out 0100/00
Issue Date: 4/07/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ••EyiVrricA.�'
Town of Southold &,0 - CQ ' Application No. /) 7 8
Judith T. Terry, Town Clerk
e .r' �_-��•;: - Residential
Town Hall, 53095 Main Road a
p, -O. Box 1179 w •� ti ; ' � Non-Residential
Southold, New York 11971 - O � ��. ,.
Telephone ( •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
•
DATE Wu 7 7
OWNER NAME: j a- ' iJ fo/Y,n,p (Aft
OWNER MAILING ADDRESS: ,P4 6y/ /0/71
OWNER PROPERTY ADDRESS: JL{o0 CAwEs /y&CK go•
OWNER TELEPHONE NUMBER: (JIc ) 7�S �� /�U •
TAX MAP NO. : Section 6 Block 7 Lot
CROSS STREET: IVi9, ) ie5 /2, i
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential // Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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 Appli .nt
RECEIVED BY:
a._hewn Clerk's Office
DATE: Anor; 998
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