HomeMy WebLinkAboutUnited Methodist Church of Cutchogue z
. cam . �. Town Hall, 53095 Main Road
` � ,*
.,> P.O. Box 1179
0 0. Southold, New York 11971
JUDITH T.TERRY -.... ..~.00°�, � TELEPHONE
TOWN CLERK (516) 765-1801
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. 692-R Residential X Non-Residential
Fee $ 10 . 00 Septic Cesspool X
New Existing X
Name Of Owner UNITED METHODIST CHURCH OF
Mailing Address 1 CUTCHOGUE
Mailing Address 2 P.O. BOX 701
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 29650 MAIN ROAD .
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6033
Tax Map No. section 103 . 00 block 1 lot 7. 000
Cross Street STILLWATER AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 5/05/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold �CQ Application No.‘
,
Judith T. Terry, Town Clerk :-- a
Town Hall, 53095 Main Road Residential
p. O. Box 1179 (.fl ,' Non-Residential
Southold, New York 11971 0y�o '�•�`�
Telephone ( •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0
DATE / /77,4-A
OWNER NAME: j -r- ) /21CT/hc2isr one1k p� C.-0TQJLO6JJ. k.7
OWNER MAILING ADDRESS: 'C 560X. -701
e.0 Yo / c Ey i/y3s
OWNER PROPERTY ADDRESS: R265-0 /)?n/A/ /?a 4-b
VT e O 5-6E
OWNER TELEPHONE NUMBER: 3y -6633
TAX MAP NO. : Section /0,3 Block / Lot 7
CROSS STREET: /,LL 4J,41-7-E AritivE.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential - Non-Residential
- DATE OF PREVIOUS PUMP-OUT: /r2fn(J-/ 1527
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.)
1 . Signature of Applicant
jA.
RECEIVED BY:
RECh? C rk's O fice
DATE: MAY 051988
Tom Clerk Southold