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JUDITH T. TERRY t Town Hall, 53095 Main Road-
TOWN CLERK t, P.O. Box 1179
REGISTRAR OF VITAL STATISTICS r`� -:` Southold, New York 11971
MARRIAGE OFFICER � 0., Fax (516) 765 1823
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(516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3046-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner VOIGT, EMIL AND IRMA
Mailing Address 1 1125 WEST COVE ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1125 WEST COVE ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7866
Tax Map No. section 111 .00 block 3 lot 14.000
Cross Street VANSTON ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/28/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK sCOFDC,�
Town of Southold V� CQ ' Application No.3°� 6Judith T. Terry, Town Clerk:
Town Hall, 53095 Main Road ;, $10.00 - Residential
P. O. Box 1179 cr' :
$25.00 - Non-Residential
Southold, New York 11971 4' .0
Telephone �,( '� '�
•
(516) 765-1801
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
RECEIVED
OPERATION PERMIT
JUN 18 1993
SEPTIC TANK or CESSPOOL
Southold Town Clerk
•
Operation Permit No.
Fee $ Io
DATE aN - IF3 , f�� 3
� Vole"
OWNER NAME: it' 7' P'rL 11 ‘10-1‘-i
OWNER MAILING ADDRESS: CII -5 IN `moo °\ 1
rf•1-7- o qv
1.(�vJ 7'a 2K cif 93S
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: -73
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TAX MAP NO. : Section /l l Block " 5 Lot / L/
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
g
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: JCV'v`G , 1-9 3
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.)
cz_
i
Signature of r pplicant
RECEIV D BY: •
Town Clerk's Office
DATE: - ( e - q
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