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ELIZABETH A.NEVILLE u �* Town Hall, 53095 Main Road
TOWN CLERK = + P.O. Box 1179
e, '" � Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �s* ®�'°1 Fax(516) 765-1823
MARRIAGE OFFICER ®� °���i� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER i�
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. 3809-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner TERRY, GEORGE AND JUDITH
Mailing Address 1 P. O. BOX 41
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 600 HIGHWOOD ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5422
Tax Map No. section 78.00 block 9 lot 46.000
Cross Street NORTH BAYVIEW ROAD
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Issue Date: 8/24/98 E Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �C31FO(,t'
TOWN OF SOUTHOLD Off. Application NQJVP
ELIZABETH A.NEVILLE,TOWN CLERK lj $10.00 - Residential L/
P.O.BOX 1179
1,,��1 $25.00 - Non-Residential
SOUTHOLD,NEWYORK 11971 *'$
- Telephones(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /6
DATE August 22, 1998
OWNER NAME: George & Judith Terry
OWNER MAILING ADDRESS: F0 Box 41
Southold NY 11971
OWNER PROPERTY ADDRESS:s600 Highwood Road
Southold NY 11971
OWNER TELEPHONE NUMBER: 516-765-5422
TAX MAP NO. : Section 78 Block 9 Lot 46
CROSS STREET: North Bayview Road
TYPE OF SYSTEM: Septic Tank X New Existing X
Cesspool X New Existing X
Residential X 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.)
•
Signature of Appl'••.nt
RECEIVED BY:
Town C rk's ffice
DATE:
•
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