HomeMy WebLinkAboutTuthill (3) is
JUDITH T. TERRY �� y` Town Hall, 53095 Main Road
TOWN CLERK g i P.O. Box 1179
REGISTRAR OF VITAL STATISTICS r rt Southold, New York 11971
MARRIAGE OFFICER .%104.
Fax (516) 765-1823
® ®�r� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1669-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner TUTHILL, JOHN C.
Mailing Address 1 3910 ELIJAH LANE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 3910 ELIJAH ALNE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8654
Tax Map No. section 108.00 block 3 lot 1 .000
Cross Street COUNTY ROAD 48
Date Of Last Pump Out 0/00/00
Issue Date: 4/18/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
IIS
OFFICE OF THE TOWN CLERK S�FFO(,e
Town of Southold � _ �� Application No. /C
Judith•% 'T T$rry, Town Clerk ilf11, 4y:�
$10.00 - Residential
Town ,all, 53095 Main Road 1,
.•C
P. O. Box 1179 cry .1&-31.4 ',1-, r n • $25.00 - Non-Residential
Southold, New York 11971 Q ® J
Telephone �( `��®
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE d/?
OWNER NAME: Ci Oa N e .
•
OWNER MAILING ADDRESS: ,9 gra gl✓1� �,�j /ii--
/VIA 1"r *1"v-f_rf;{ ► �'`a� fir q$i—
OWNER PROPERTY -ADDRESS`:-___„
OWNER TELEPHONE NUMBER: (3776
TAX MAP NO. : Section /11a'', Block 3 Lot
CROSS STREET: 0.‘,#),0 /244
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New ,f/ 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.)
ignature of Applicant
RECEIVED BY:
own lerk's Office
DATE: V /7 71/
j 0 tiff e• 1,77.1-1 L2 -
• // /4-`
1-4
`�l