HomeMy WebLinkAboutNunemaker or
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JUDITH T.TERRY 4t gik k-." Town Hall, 53095 Main Road
TOWN CLERK r. . i P.O. Box 1179
< �t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS % �m 1
MARRIAGE OFFICER �;��� �"` ��® ���/ Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER - iiTelephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER •••�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3720-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner NUNEMAKER, JAMES
Mailing Address 1 480 TUTHILL ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 480 TUTH I LL ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5913
Tax Map No. section 55.00 block 3 lot 18.001
Cross Street YENNECOTT DRIVE
Issue Date: 11/12/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
'S.
OFFICE OF THE TOWN CLERK /cjvFF�(�•
A lication
Town of Southold Q1.\= pp ' No.3 7
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - ResidentialvV
p. O. Box 1179 (.n '' �' $25.00 - Non-Residential
Southold, New York 11971
Telephone NN� '�•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /D
DATE ///,7/7
OWNER NAME: Ja,,9ae0r 4,412 e d'JVrp,,—
OWNER MAILING ADDRESS: 12(2 /UM/ Y/ / i.
�'v/170/x, /1/Y, //97/
_ OWNER PROPERTY ADDRESS : -Carize ad Q101/4
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 55-- Block '3 Lot / 0-7
CROSS STREET: ye,m/ &C ' 7'7- or-
TYPE
r-TYPE OF SYSTEM: Septic Tank k/ New Existing
Cesspool V.
New Existing
Residential 7 > Non-Residential
Sys/ern k'f ;0./4/4,e, ///efr3 ?5U
t/I(w / dos( G1q-. A.,//71.
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 Applicant
RECEIVED ,BY:
Town Clerk's Office
DATE:
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