HomeMy WebLinkAboutTuthill (11) OFFICE OF THE TOWN CLERK • .c0FIRJ(11O
Town of Southold
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Judith T. Terry, Town Clerk A `� 0 .
Town Hall, 53095 Main Road �.a
P. O. Box 1179 �,� 45- � r
Southold, New York 11971 V,
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 458 Residential x
Non-Residential
Fee $ 10.00
Septic Cesspool X
NAME OF OWNER: Ralph W. Tuthill, Jr.
OWNER MAILING ADDRESS: P.O. Box 26
Mattituck, New York 119c7
OWNER PROPERTY ADDRESS: 4575 Wickham Avenue
Mattituck, New York
OWNER TELEPHONE NUMBER: 516-298-8087
TAX MAP NO. : Section 107 Block 4 Lot 8.1
CROSS STREET: Mary's Road
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing _ x
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: December 1984
eirease074/0.00
Judith T. Terry
Southold Town Clerk
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DATE: October 13, 1987
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c\WFOUr
Town of Southold d� 3 . CO, Application No. ysi
Judith T. Terry, Town Clerk �� *}a
Town Hall, 53095 Main Road Residential
P. O. Box 1179 tr3 � 3t . Non-Residential
Southold, New York 11971 O .Q51.` --`,;7 $.`
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Telephone _(1 %P• .`
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /6 o®
DATE g>/
• OWNER NAME: Ralf 11 'C . 7 1 /i ) j1
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OWNER MAILING ADDRESS: P 0 , sox cah
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OWNER PROPERTY ADDRESS: 174,51.5" (tet//644 I?{V/
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OWNER TELEPHONE NUMBER: aQ ? F.-- YOE 7
TAX MAP NO. : Section /49 -- Block `T' — Lot 8 j
CROSS STREET: meys lee) 41,
TYPE OF SYSTEM: Septic Tank / New Existing
Cesspool t- New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: d 210
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
015 of distance, approximately, to building and closest road.)
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cU//ff' o�,)0( p°(is� Av0 Signature of Applicant
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RECEIVED BY:
MEW"n Clerk's 0 ice
DATE: OCT 13 1987
down Cterlt Southold