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Eri r77 Town Hall, 53095 Main Road
r-;" -. - ,�I P.O. Box 1179
�m4 ��®°�I Southold, New York 11971
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JUDITH T. TERRY A� 0TELEPHONE
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. 1052-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner TAYLOR, ESTHER R.
Mailing Address 1 320 STROHSON ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 320 STROHSON ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6859
Tax Map No. section 103.00 block 10 lot 19.000
Cross Street LITTLE NECK ROAD
Date Of Last Pump Out 0/00/71
Issue Date: 3/15/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
'a.
OFFICE OF THE TOWN CLERK ��
Town of Southold -c'6_' Application No. /dam' 2—
Judith T. Terry, Town Clerk �` = ". 4 ► I Residential
Town Hall, 53095 Main Road _
.0
P. O. Box 1179 Non-Residential
Southold, New York 11971 _ . �o*-$
Telephone 1 Y► 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ,
Fee $ / vS
DATE /a//q
OWNER NAME: CCL-( ) ,e7 o
OWNER MAILING ADDRESS: ® v<— feet-0-4_
Vy / ( 9156
OWNER PROPERTY ADDRESS:___ _
OWNER TELEPHONE NUMBER: ( 6 ' 714 -6 F67
TAX MAP NO. : Section /0 3 Block IC Lot i !'
CROSS STREET: iglak
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing �-
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: l q `J I
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 Appli, ;nt
RECEIVED BY: -`
.,`..A3510 Clerk's Office
DATE: UR 1 5 19to
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