HomeMy WebLinkAboutTuthill (4) .1°." ULTC.
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"` . �; Town Hall, 53095 Main Road
��` P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY yrs ,, I,' TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OE VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 812-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner TUTHILL, P. DANIEL
Mailing Address 1 P. O. BOX 1442
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 55 HOBART ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1884
Tax Map No. section 62.00 block 3 lot 9.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/06/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK o�� �'--
Town of Southold � 4 CSG•_ Application No. Oa
Judith T. Terry, Town Clerk �� w�a,
Town Hall, 53095 Main Road ' '`' '� Residential
F
P. O. Box 1179 Lc 3j%Z z z Non-Residential
Southold, New York 11971 ®A T` •*$
Telephone j
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 7i' A
• OWNER NAME: ► �P( &/ /! //J
OWNER MAILING ADDRESS: rJ ' • 8/7-17/K/2-1
d 0,114V
OWNER PROPERTY ADDRESS: e�
OWNER TELEPHONE NUMBER: 7C.)-- Mfg +•
TAX MAP NO. : Section 6-2- 0 0 Block 0 O O Lot De ® c0 b
CROSS STREET: X,1/4/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool c/ New Existing
Residential Non-Residential
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.)
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Signature of Applicant
RECEIVED BY:
REM=Clerk's Office
DATE: SEP OAP : :
•
Tuan MIR Southold
.) U 1414
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