HomeMy WebLinkAboutTuthill (5) OFFICE OF THE TOWN CLERK ' 'Oak
Town of Southold , ry,
Judith T. Terry, Town Clerk 44
Town Hall, 53095 Main Road T
P. O. Box 1179 t.r3 - " r
Southold, New York 11971 \ p ' - - Off- ••
Telephone _ �( r' i l b
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 610 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool x
•
NAME OF OWNER: David A. Tuthill
OWNER MAILING ADDRESS: P.O. Box 911
Mattituck, New York11952
OWNER PROPERTY ADDRESS: Pike Street
Mattituck, New York 11952
OWNER TELEPHONE NUMBER: 516-298-4507 •
TAX MAP NO. : Section 140 Block 2 Lot 26
CROSS STREET: Wickham Avenue
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: October 8, 1987
rf<,, Judith T. rry
Southold Town Clerk
DATE: February 16. 1988
-.(TOWN SEAL)
'! 'f �i
OFFICE OF THE TOWN CLERK c,\\FFO(A
Town of Southold 4t re --
Application No
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
,�S .�� - Residential
T �p•
P. -O. Box 1179 �i z' Non-Residential
Southold, New York 11971 O ® ' '`, �•`
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
ifittitiZEID SOUTHOLD WASTEWATER DISPOSAL DISTRICT
MN 11 ! 7,
APPLICATION
man
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
6/6
Operation Permit No. „0
Fee $ /O .
DATE c,A, 7, 8'8
OWNER NAME: /917 Lb 4, l ,7--/4-/LL
OWNER MAILING ADDRESS: Po. 13O j q//
/II A-Tr/ -� c1�, ���/ ` /1� 50Z__
OWNER PROPERTY ADDRESS: P//- E JT/2 EET
/1'I4 rr/rvc_/ ( ' ' / il7s�
OWNER TELEPHONE NUMBER: c2 9k . 27/..6-0
7
TAX MAP NO. : Section / 1-71°' Block Lot .2- �o
CROSS STREET: J / c/< / ,4H AVE
TYPE OF SYSTEM: Septic Tank New Existing I
Cesspool New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: /0/S/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.)
/ �
Signatu e of Applicant
RECEIVED BY:
own�Clerk�ffice
DATE: /� �'
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