HomeMy WebLinkAboutTuthill (6) /70.10,1:...
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Town Hall, 53095 Main Road
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�!' P.O. Box 1179
s, !' Southold, New York 11971
NDITH T.TERRY =. . .�L 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. 1424-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner TUTHILL, REGINALD F.
Mailing Address 1 P. O. BOX 86
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 225 SKIPPERS LANE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-3558
Tax Map No. section 24.00 block 2 lot 5.000
Cross Street OYSTERPOND LANE
Date Of Last Pump Out 0/00/00
Issue Date: 3/19/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK cOFOUr
Town of Southold C A lication No.
Judith T. Terry, Town -Clerk '' �G :i - ��
Town Hall, 53095 Main Road -< $10.00 - Residential idential
p, O. Box 1179 cryWO, ',� i f $25.00 - Non-Residential
Southold, New York 11971 O"(IN
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Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 3/C1 90
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'OWNER NAME: OVA i) r ( r C•f (L L
OWNER MAILING ADDRESS: . 0 . arr O cj
Otergd r /-Y - / QS-7
OWNER PROPERTY ADDRESS: Z 25 .S1c ppe/S Ai9-/i
Ole( /1-.1V /fid
OWNER TELEPHONE NUMBER: 3 2 3
TAX MAP NO. : Section / Block Lot
CROSS STREET: 0 ys j-' a2 Pa,1OS 1-104)C--
TYPE
^)&tTYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Xr 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
�P p, of distance, approximately, to building and closest road.)
67 ‘ -6 Ell 2 I E-
t"kW -• t 12 A 40 17,
p2p, T Sigrrature of Appli' ant
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RECEIVED BY:
Town Clerk's Office
DATE: