HomeMy WebLinkAboutTuthill (2) •
Town Hall, 53095 Main Road
05,
P.O. Box 1179
,*--V �� �� Southold, New York 11971
JUDITH T.TERRY
�� FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 1118-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner TUTHILL, ALLYN R.
Mailing Address 1 1250 OREGON ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1250 OREGON ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-48211
Tax Map No. section 100.00 block 4 lot 3.000
Cross Street MILL LANE
Date Of Last Pump Out 8/29/86
Issue Date: 5/23/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK r seFO
Town of Southold Application No`1/,
Judith T. Terry, Town Clerk ,` z•- �°
Town Hall, 53095 Main Road E"="5
Residential
P. O. Box 1179 cn 't.r �` Non-Residential
Southold New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME:
OWNER MAILING AD RESS: /c. .,5-70
OWNER PROPERTY ADDRESS: W ..2—,
OWNER TELEPHONE NUMBER: c
TAX MAP NO. : Section /(j 0 Block 46 Lot J
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ,.X New Existing
Residential )C Non-Residential
DATE OF PREVIOUS PUMP-OUT: ati-t, c729,/ /?ec7�P
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.)
�
g ederi�of lfipph nt��
RECEIVED BY:
tot-vi n Clerk's Office
DATE: MAY 23 Ma
Tam got: