HomeMy WebLinkAboutNugent JUDITH T.TERRY __. "` Town Hall,53095 Main Road
TOWN CLERK "` 'E g P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER Fax(516)765-1823
RECORDS MANAGEMENT OFFICER ®�Q �� Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3343-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner NUGENT, RAYMOND H.
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Mailing Address 1 P. O. DRAWER 5027
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Mailing Address 2 55 SOUTH ETNA AVENUE
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City St Zip MONTAUK NY 11954-0000
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Property Address 1 745 PINEWOOD 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. 516-668-2200
Tax Map No. section 110.00 block 3 lot 8.000
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Cross Street SOUTHERN CROSS ROAD
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Issue Date: 5/25/95 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold O�� CQG Application No.
Judith I. Terry, Town Clerk Z y
To}n n Hall, 53095 Main Road $10.00 - Residential t�
P. 0. Box 1179 to $25.00 - Non-Residential
Southold, New York 11971 O
Telephone 41
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE MAY 1995
OWNER NAME: REVEREND 'RAYMONDDH. NUGENT
55 SOUTH ETNA AVENUE
OWNER MAILING ADDRESS: POST DRAWER 5027
MONTAUK, NEW YORK 11954
OWNER PROPERTY ADDRESS: 745 PINEWOOD ROAD
CUTCHOGUE, NEW YORK 11935
OWNER TELEPHONE NUMBER: CUTCHOGUE 734-7533-
MONTAUK 668-2200
TAX MAP NO. : Section 110 Block 3 Lot 8
CROSS STREET: SOUTHERN CROSS ROAD
TYPE OF SYSTEM: , Septi,c Tank ,., New Existing
Cesspool xxxx New Existing xXXX
Residential xxxx Non-Residential
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.)
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Signatulre of Applicant
RECEIVED BY:
To „Cle .k's Office
DATE:
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