HomeMy WebLinkAboutNovit JUDITH T. TERRY < Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179,
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
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. 1632-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner NOVIT, MARY H.
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Mailing Address 1 P. O. BOX 102
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Mailing Address 2
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City St Zip CUTCHOGUE NY 11935-0000
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Property Address 1 1530 NEW SUFFOLK ROAD
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Property Address 2
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City St Zip CUTCHOGUE NY 11935-0000
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Owner Telephone No. 516-734-5062
Tax Map No. section 109.00 block 6 lot 13.000
Cross Street CEDARS ROAD
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Date Of Last Pump Out 0/00/70
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Issue Date: 3/01/91 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK
Town of Southold , „ �� C'�G Application No.
Judith T. Terry, Town Clerk - y
Town Hall, 53095 plain Road ` $10.00 - Residential
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P. 0. Box 1179 u' $25.00 - Non-Residential
Southold, New York 11971 O ® ZF�
Telephoneoj
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: T,� l7 ��
OWNER MAILING ADDRESS: � do �X J 0Y2
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OWNER PROPERTY ADDRESSA/6 V
OWNER TELEPHONE NUMBER: 7`�j — � '
TAX MAP NO. : Section Block Lot d !_
CROSS STREET: /Y O'M "7-1
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: (� y _ Q L,_ -F &2- ( y=-15
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.)
Sign@Xure of Applicant
RECEIVED BY:
TownClerk's' Office
DATE: RON ���
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