HomeMy WebLinkAboutWeston '
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Town Hall, 53095 Main Road
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®2 P.O. Box 1179
Z �1 �0.Southold, New York 11971
JUDITH T.TERRY � FAX(516)765-1823
TOWN CLERIC TELEPHONE(516)765-
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. 1178-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner WESTON, DOUGLAS O. H.
Mailing Address 1 700 OLD MENHADEN ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 700 OLD MENHADEN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6378
Tax Map No. section 111 .00 block 4 lot 20.000
Cross Street WUNNEWETA ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/30/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c0FRUr '-
Town of Southold � C'11� Application No// 7g'
Judith T. Terry, Town Clerk 4 -1
� $10.00 - Residential
Town Hall, 53095 Main Road .
P. 0. Box 1179 "' ' .Wyi
$25.00 - Non-Residential
Southold, New York 11971 4f "`
Telephone �( `.ogo
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE S
OWNER NAME: 0+-`- O� 14 Ii(Jv31 •
•
OWNER MAILING ADDRESS: 1(9O OLD crn/t/d ocet,t)
eat-AO-06(a .C1
OWNER PROPERTY ADDRESS: CYC
OWNER TELEPHONE NUMBER: i6) 701,4
TAX MAP NO. : Section /1 / Block Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool f/- New Existing
Residential 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
of distance, approximately, to building and closest road.)
S'gnature of Applicant
RECEIVED BY:
ag ` , lerk's Office
DATE: AIN 3 �� �
�Sr
4