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OFFICE OF THE TOWN CLERK • 'OFOU(C"
Town of Southold OG
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road -=
P. 0. Box 1179
Southold, New York 11971 `).4?›�y
Telephone "'Ol * '
(516) 765-1801 _
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or. CESSPOOL
Operation Permit No. 614 Residential x
Fee $ 10.00 Non-Residential
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• Septic , Cesspool x
NAME OF OWNER: John R. and Beatrice A. Murphy
OWNER MAILING ADDRESS: P.O. Box 248
Peconic, New York 1"1958
OWNER PROPERTY ADDRESS: 2220 Depot Lane
Cutchogue, New York •1395
OWNER TELEPHONE NUMBER: 5I6-765-1626 •
TAX MAP NO. : Section 102 Block 2 Lot 3
CROSS STREET: Route 25 -
TYPE OF SYSTEM: Septic Tank ' New Existing
Cesspool X New X Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: N/A
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egvi641441.17"..
Judith T. TeMry
" Southold Town Clerk
DATE: February 22, 1988 - -
(TOWN SEAL) j
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OFFICE OF THE TOWN CLERK 'c�vFFUL -
Town of Southold CD Application No.
Off, G •,
Judith T. Terry, Town Clerk - � �` Residential
Town Hall, 53095 Main Road a .; �;?,P. 0. Box 1179 U' ® �O 1� Non-Residential
Southold, New York 11971 O �0�,�/
Telephone zytt
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- - - for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
CouSr
O t- Permit No. 02 7
Fee $ le.)% r
DATE e.3
OWNER NAME: 32nj ,Q, + /3 ',4 7 7'fce n /1-,001
OWNER MAILING ADDRESS: ,i0p_ �/9, ' /P:04yf
'Q A PE cc 's?' o . //F1
_ OWNER PROPERTY ADDRESS: ?0.00ll a ��d7 4/9.
/cAOQIl�
OWNER TELEPHONE NUMBER: ( '0)
TAX MAP NO. : Section /0 g Block Lot 3
CROSS STREET: /d T.;cs” / 44.
TYPE OF SYSTEM: Septic Tank New v Existing
Cesspool New Existing
Residential t/ Non-Residential
-- DATE OF PREVIOUS PUMP-OUT: ,11//Q
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.)
/41. .-'7/7/
Signature of A -..I' ant
RECEIVED BY: f3 e e
Town Clerk's Office
DATE: IaalkV
_ SUFFOLK CO. HEALTH DEPT. APPROVAL
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r- 1 w H. S. NO.
fCa __ .r"--�-� �`t s' i` �' j '4� _ /" r_s �-- , � -�--1/- `di.• + STATEMENT OF INTENT i.
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j �r_ J.p%[i<I �! �' t.t THE WATER SUPPLY AND SEWAGE DISPOSAL
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1 • , `• — SYSTEMS FOR THIS RESIDENCE WILL
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• {1- =•--- .y '" CONFORM TO THE STANDARDS OF THE
's ._-_-_---7...-- • 1- �' .J SUFFOLK CO. DEPT. OF HEALTH SERVICES.
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V� i j) '. / SUFFOLK COUNTY DEPT. OF HEALTH
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�_ �� (� SERVICES - FOR APPROVAL OF
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1 41 1 ,y t1" CONSTRUCTION ONLY
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RODERICK VAN TUYI. P,C.• a
- LICENSEDLAND SURVEYORS V `l Yr J,r
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- ' '1, GREENPORT NEW YORK
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TELEDYNE POST N81329 -