HomeMy WebLinkAboutWickham's Fruit Farm C h 1
JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK ®
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS tf2o L;;;: Southold, New York 11971
MARRIAGE OFFICER � Fax (516) 765-1823
e 'J, 'r ( • Telephone (516) 765-1801 •
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1804-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner WICKHAM'S FRUIT FARM
Mailing Address 1 MAIN ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5637
Tax Map No. section 109.00 block 1 lot 12.000
Cross Street
Date Of Last Pump Out 0/00/00 •
Issue Date: 11/14/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE Of THE TOWN CLERK cvFF = y
Town of Southold % 31 .4%; Application N o. /V
Judith T. Terry, Town Clerk
$10.00 - Residential
Town Hall, 53095 Main Road
P. O. Box 1179 z $25.00 - Non-Residential
Southold, New York 11971rO ��`
Telephone 0.(' 'Ng'
s'
765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION -
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ dt
DATE 20.1., /4--- f/
OWNER NAME: W/e 1.1 , r
OWNER MAILING ADDRESS: 1'14tett
01-3
OWNER PROPERTY ADDRESS: _ - - - -
OWNER TELEPHONE NUMBER: 73
TAX MAP NO. : Section Block Lot
- - -• CROSS STREET: —"
TYPE OF--SYSTEM:- Septic Tank New Existing
Cesspool New Existing
Residential v Non-Residentialre
DATE OF PREVIOUS PUMP-OUT: 4,
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.)
Signature-of Applicant
RECEIVED BY: ,
Town Clerk's Office
DATE: -
M W.K--F 550,0.63) r - - - - r
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