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JUDITH�T:'TERRY �!1 �� :� Town Hall, 53095 Main Road
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REGISTRAR OF VITAL STATISTICS „ P.O. Box 1179
TOWN CLERK ® .r Mx„
9
�y Southold, New York 11971
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MARRIAGE OFFICERy :4?
� r* r Fax (516) 765-1823
N,, aoP",, Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1715-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner NANCY GREENE TRUSTEE
Mailing Address 1 P. O. BOX 7556
Mailing Address 2
City St Zip INCLINE VILLAGE NV 89450-0000
Property Address 1 1395 AQUAVIEW AVENUE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 702-831-5511
Tax Map No. section 22.00 block 2 lot 2.000
Cross Street ROCKY POINT ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 7/02/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE *OF .THE TOWN CLERK 5\\VF00(
Tonn of Southold �0 ,�. CQ Application No. l
7/ 5--
Judith
Judith T. Terry, Town Clerk . .`.._i:
Town Hall, 53095 Main Road .... ai"• . $10.00 - Residential
P. O. Box 1179 '-f=® !5 ;?'?,, �. $25.00 - Non-Residential
Southold, New York 11971 OO , �Oc '��J
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT .
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ x) °'
hctl
` 7 0,. DATEl r� J I
. OWNER NAME: VtiAA„\n lS N_42J[1�, k.RA •
OWNER MAILING ADDRESS: i).0. - 01., 75S
MQA Ne VI (I0 s NgwA°C)A Itig0 ,
OWNER PROPERTY ADDRESS:i '\3�1g. Ni)�,A )xL• N)V-ci1
W\R\ 00 1 ►\ / I tG6ef
OWNER TELEPHONE NUMBER:0OZ.) �f l-bs I ( (5 9417—D 15 7
TAX MAP NO. : Section aa. Block e2 Lot o2
CROSS STREET: K be K / ro c g_)-t- 20-,-() .TYPE OF SYSTEM: Septic Tanddk New Existing
Cesspool ,/ New J Existing
Residential ,, Non-Residential
DATE OF PREVIOUS PUMP-OUT: N""J
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.)
(Th /
1
Signature .4 Apicant
RECEIVED BY: 6,e C0.,,0p_,,,
T/72747
ClArk's Office
DATE: V.
maintenance costs of the facility. The user fee was established at 2 cents per
gallon and was put into effect on July 14, 1986. The fee previously charged
for disposal at the Cutchogue Landfill for no treatment was 1 cent per gallon.
The "Southold Scavenger Waste Disposal Law" was based on the guidelines
of USEPA/NYSDEC and was adopted by Town Board resolution on Juiy 30,
1985.
The law requires the following permits and application fees to be filed
with the Town of Southold:
1. Septic or Cesspool Construction, Alteration and Modification Permit:
'/Residential - $ 10. 00 per occurrance per premise
Non-Residential - $ 25. 00 per occurrance per premise
2. Septic or Cesspool Operation Permit:
/Residential - $ 10. 00 per homeowner per premise
Non-Residential - $ 25. 00 per owner per premise
The Construction, Alteration, and Modification Permit will be required for
any new or existing construction work to be conducted on septic tanks and/or
cesspools. The Operation Permit will be required for each newly constructed
premise. In addition the Operation Permit will be required at the time existing
systems are pumped out. -
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