HomeMy WebLinkAboutTravers Town Hall, 53095 Main Road
CP � ,,v �, ` P.O. Box 1179
_ "14 Z�' Southold, New York 11971
JUDITH T.TERRY = _®� ' . .i•��" TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR Oh VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 814-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner TRAVERS, EUGENE
Mailing Address 1 15 NORMANDY LANE
Mailing Address 2
City St Zip MANHASSET NY 11030-0000
Property Address 1 MASON DRIVE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-627-7048
Tax Map No. section 104. 00 block 5 lot 35. 000
Cross Street HAYWATER DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 9/06/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK Qc�;:foii' y
Town of Southold �; L'0 = Application No. o
ty
Judith T. Terry, Town Clerk Residential
Town Hall, 53095 Main Road " t .
P. 0. Box 1179 cnA; i ; Non-Residential
Southold, New York 11971 s
Telephone -1` •
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE -1 7
OWNER NAME: EUOEN? r./ e5.
OWNER MAILING ADDRESS: /•5 /�/C/i1'�A,JU7NJ
/29, /,95 7 /IJ - // s-•F‘'
OWNER PROPERTY ADDRESS: / 9.5e74J DEP/V -
7'°e/5/oCU�
OWNER TELEPHONE NUMBER: 27C Com,/- 76-'4
TAX MAP NO. : Section /017L Block � Lot -35-
CROSS STREET: //7/0/97 '
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: -5--1.?
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: ,4vy-ate` C�
Town Clrk's Off ce
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DATE: o' - /�V
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