HomeMy WebLinkAboutWoodhull Wire;
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Town Hall, 53095 Main Road
ti u P.O. Box 1179
®1Southold,New York 11971
JUDITH T.TERRY ��!��1 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. 781-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New X Existing
Name Of Owner WOODHULL, TERRY
Mailing Address 1 1730 COUNTRY CLUB DRIVE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1730 COUNTRY CLUB DRIVE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7243
Tax Map No. section 109. 00 block 3 lot 2.017
Cross Street MOORES LANE
Date Of Last Pump Out 0/00/00
Issue Date: 8/09/88 Judith T. Terry
Southold Town Clerk
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(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ��FU7(
Town of Southold ��� rCQG; Application No. �o
Judith T. Terry, Town Clerk #i ,
•
Town Hall, 53095 Main Road -< 7 Residential
P. 0. Box 1179 � Non-Residential
Southold, New York 11971
Telephone .01
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1 t
Fee $ 1(�
• DATE S' 9 ge
OWNER NAME: Tc.,E^r y (i eve,40-1I
OWNER MAILING ADDRESS: 030 ecuAirry «U 3 .0/?
ewecoo gob-
OWNER PROPERTY ADDRESS: 1130 C rAc -�� e. pa
c itod v-a-
OWNER TELEPHONE NUMBER: `)311-- ) -ii)
TAX
TAX MAP NO. : Section /61' Block Lot a.
CROSS STREET: tv04 g S
TYPE OF SYSTEM: Septic Tank +► New Existing
Cesspool New q.,"" Existing
Residential � Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1
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.)
Sig ture o pplicant
RECEIVED BY: jc„c / . , 06—N-2c2L,J
Town Cle 's Offic
DATE:
AUG 0979
Town vert swam
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. DAT'JUL 61988 K8.WAD.. • • - - - • -
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The sewage disposal and wat3er supply tacrtitiies ter • •• -
location have been inspected by this Department eocllat
other c' and r t� .l,e� r
of Bureau of O eetw'a ter Maine
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