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JUDITH T. TERRY ` Town Hall, 53095 Main Road
TOWN CLERK : P.O.r= P.O. Box 1179
U' �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = BYO �� Fax (516) 765-1823
MARRIAGE OFFICER ` aO•I�
RECORDS MANAGEMENT OFFICER ��i� Telephone (516) 765 1801
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3198-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner TUTHILL, STEPHEN J.
Mailing Address 1 115 WEST COVE ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 50 HARBORVIEW AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-734-2672
Tax Map No. section 100.00 block 1 lot 43.000
Cross Street VAVE CREST LANE
Issue Date: 5/19/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
r r
OFFICE OF THE TOWN CLERK 'c�VFFO(,'�
Town of Southold �� t CQ ' Application Noy&
Judith T. Terry, Town Clerk . Y 1,*”.
�►
Town Hall, 53095 Main Road $10.00 - Residential
p. O. Box 1179 v' $25.00 - Non-Residential
Southold, New York 11971 '
Telephone
���*''
Telephone = It '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No.
Fee $
DATE
OWNER NAME: e J , I i HILL
OWNER MAILING ADDRESS: /I5 W c Sri° Cove 9-010
CL.y ct-( o &Ue yf \i\35
OWNER PROPERTY ADDRESS: 5 p 11^N1f �IUF
M A-Tri 7Q Lk
OWNER TELEPHONE NUMBER: -13 LI a .
TAX MAP NO. : Section (G C Block I Lot L
CROSS STREET: L.) ANEC S .S D Lo ��
TYPE OF SYSTEM: Septic Tank New V Existing
Cesspool New p/ Existing
/
Residential 'v Non-Residential
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.)
Signatur of Applicant
RECEIVED BY: `VLA
Town Clerk's Office
DATE: T/3-191i
1 91i
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NOTE::-='L%.'y'W ',;' 1,,`°' ' `-'-':', �„'''<<' - „
I.SUBDIV ISION:MAR.,FI'LED IN THE "OFFICE OF THE -
- CLERK:''OF'SUFFOLKt'COUNTY`,ON;MAY 27;;1988 AS .
:FI LE�*NO''853 2-. : :,:'s., i'-:i=- ' ' '
2: £:STAKE`FOUNO ”' ..%::".;,.F.--,i-;,-1 • i; .. . . :_.
is rr'. ,.,....L>,..,,,-,,,I=..,,. .(_Y ',...:;;:'...K.,..,,._,
. 1 -
SUFFOLK COUNTY`DEP'ARTMENT.OF,-HEALTH' SERVICES CERTIFICATION SURVEY FOR: . -
1 AM'FAMIUAR'WITH THE'STANDARDS FOR APPROVAL'AND CONSTRUCTION OF SUBSURFACE
SEWAGE;DISPOSAL,SYSTEMS,FOR SINGLE FAMILY RESIDENCES,AND WILL ABIDE BY THE CONDITIONS STEPHEN J. TU T H I LL a SUSAN' C. Tl;
SET,FORTH'THEREIN AND ON THE PERMIT.TO CONSTRUCT." LOT NO. 5, "OREGON HEIGHTS-" , - ' .