HomeMy WebLinkAboutWickham's Fruit Farm (2) Off QUI
47>
JUDITH T.TERRY zz 51 Town Hall, 53095 Main Road
TOWN CLERK _-
z4<; 'l� t P.O.Box 1179
�� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS '♦�� ®�, " 1 Fax(516)765-1823
MARRIAGE OFFICER �1�
RECORDS MANAGEMENT OFFICER � ed Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ,••0�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3352-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner WICKHAM'S FRUIT FARM
•
Mailing Address 1
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1555 NEW SUFFOLK ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5637
Tax Map No. section 109.00 block 7 lot 10.002
Cross Street MAIN ROAD
Issue Date: 6/28/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
P
ti IIS
OFFICE-OF THE TOWN CLERK • \ Fp0.�'-
-� Town of Southold Q e4--=‘ Application
Judith T. Terry, Town Clerk .� ►
Town Hall, 53095 Main Road -< l $10.00 - Residential
p. O. Box 1179 to ;'
'��� $25.00 - Non-Residential
Southold, New York 11971
Telephone 40( * 101
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ID, •
DATE r 2-I 1
OWNER NAME: ' m
OWNER MAILING ADDRESS: re. es`� o 10R-- ' � t' ( c".
OWNER PROPERTY ADDRESS: .{ S'S-5� Vl.e-44' ✓.��v ii %ea�
6. ,, Q '21 / . ,,
OWNER TELEPHONE NUMBER: (51(,) -7 3� 5c 3 7
TAX MAP NO. : Section Block. '7 Lot la,
CROSS STREET: _
TYPE OF SYSTEM: ; Septic,Tank, New Existing
Cesspool New Existing
Residential ✓ 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.)
e e
Signature of Applicant
RECEIVED BY: /DI l
. Town Clerk's Office - - ---
DATE: 6// � 9
r
A ^-
TOWN OF SOUTHOLD
,,,.�g�FF0.0-c=- /,
,M . 'y; ', Ticket No. 11 5 3
SCAVENGER WASTE REPORT --�®14 00""��
I
Name of Hauleroe;)
Full �a
Permit No. / Load @ Gallons -
0 Half Load @ Gallons
Truck Capacity 14 ., 0 $ Paid
LOCATION: ' 0 Split load @ Gallons (date)
0 New 0 'I peat (Validation of Payment)
Name of Owner. . 'i' 1144.k.lewa
Street b ci
Hamlet
Telephone No.
. . . •.• ./ ..) G ax Map No. .../t6er—/—./aZ
Cross Street
DIAGRAM (Locate bui Ings and cesspool/septic s s /nnand apppprol�mat e clistan/ceeg'e
et
b-twe n uildings and system;give north arrow.)
\ .
� � l
( ,
Llfc.
af, VF
I hereby certify tha the above ogin-ated within the Town of Southold/T wn of Shelter Island
at the above loc. ion, and to th best of my'knowledge contains no chemicals, hazardous, or.
r
toxic wastes. Fal e statements, ' ade herein are pugishable as a misdemeanor pursuant to
Section 210-45 of the Penal Law of the State of New Yo , and may result in my arrest and the
impoundment of the vehicle I am dr in .
Name of Driver I
Signature of Drive
Received by , 1, • T 1,---T-7/0)�}Date ime•
�1 ,
f ,
/
(1)Treatment Plant
_%