HomeMy WebLinkAboutOliver %
Town Hall, 53095 Main Road
°Y® �1 P.O. Box 1179
41,_ l®1 ��„®•h Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 682-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner OLIVER, RICHARD I .
Mailing Address 1 2760 LITTLE NECK ROAD
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 2760 LITTLE NECK ROAD
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6744
Tax Map No. section 103 .00 block 4 lot 42.000
Cross Street WILSON ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 4/28/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
se
OFFICE OF THE TOWN CLERK c0F011( ,r0 41—Town of Southold .4; . CQG'_ Application No.
Judith T. Terry, Town Clerk . ' k
�'�° 1%1 Residential `'f•r
Town Hall, 53095 Main Road 8
P. O. Box 1179
cn - Non-Residential
�� �. F• . .
Southold, New-York 11971 O• �iol,
Telephone '�f 41i
. (516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
•
`J
• DATE Z - ZZ- - eb
OWNER NAME: 1� i C.✓r c4 4 �. )l/ vet
OWNER MAILING ADDRESS: Z76, 0 L, / 77 1- e_ `1/.
u 0/010eL-,
t!' OWNER PROPERTY ADDRESS: - �
OWNER TELEPHONE NUMBER: 73y-6 7yy
re s - 3a / L o T 7/•
Wfet
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()-.-TAX MAP NO.. Section j O_ Block r-> Lot ny'
CROSS STREET: 4.1 /s o A mac(
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool >( New Existing 2Y
Residential X Non-Residential
- Y
DATE OF PREVIOUS PUMP-OUT:
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:/ i,,,o_d/_42 S . •
-
REM -F Town ,p'erk's 0 ice
DATE: APR 2 8198
Town Clerk Southold •
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