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OFFICE OF THE TOWN CLERK c31FU(/�'`,
Town of Southold 0�'
Judith T. Terry, Town '61-
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Town Hall, 53095 Main Road
P. O. Box 1179 .u� 7
Southold, New York 119710�-
Telephone - l c ,�;
(516) 765-1801 --
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 178 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
PERMIT ISSUED TO:
NAME: Terry Woodhull
ADDRESS: Box 705
Mattituck, New York ' 11952
DESCRIPTION OF PROPOSED 'CONSTRUCTION' or ALTERATION
New Single Family Dwelling with Sanitary System
APPROVED
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Terry Woodhull
OWNER MAILING ADDRESS: Box 705
Mattituck, New York 11952
OWNER PROPERTY ADDRESS : Country Club Drive
Cutchogue, New York 11935
TAX MAP NO. : Section 109 Block 3 Lot 2, 17
CROSS STREET: Moores Lane
BUILDING PERMIT NUMBER CROSS REFERENCE:
gOir44eher-...4s#7.72.0 ../
Judith T. Term'
Southold Town Clerk
DATE: June 8, 1987
(TOWN SEAL)
' �
" >�7,,y„sir Town Hall, 53095 Main Road
Y P.O. Box 117
9
' �y ti Southold, New York 11971
JUDITH T. TERRY
Lim > TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
June 8, 1987
Terry Woodhull
Box 705
Mattituck, New York 11952
Re: Country Club Drive
Cutchogue, New York
Enclosed herewith is the Construction, Alteration or Modification
Permit for a Septic Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10. 00) for
residential use and twenty-five dollars ($25. 00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
For your general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly ?fours,
Judith T. Terry
Southold Town Clerk
Enclosures (3) -
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OFFICE OF THE TOWN CLERK SWF!)br "
Town of Southold
..
111f.► Application No. �/
Judith T. Terry, Town Clerk ri �4-,, L ; /
Town Hall, 53095 Main Road ` 8 ; Construction 1.
P. O. Box 1179 �#
Southold, New York 11971 �,y, O •!J Alteration
Telephone 0.lt r, �' Residential
(516) 765-1801 �� Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
/(—
Fee $
DATE (oA A ?
APPLICANT NAME: j L 71 ( Gi/oi peV L c-
APPLICANT ADDRESS: ,30 >c 7G
pn47"-T- fTUc- (
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION /1/6-it, Hot/54--
LOCATION
oU54LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 7,9-4/6LX tAi pU 0,0/ L,
OWNER MAILING ADDRESS: ► Ux ) 0c
�✓j.4-i T ��-vc A./-r
OWNER PROPERTY ADDRESS: e,ov.ev717 ce_vO
GUTC 0GvI
TELEPHONE NUMBER OF CONTACT PERSON: (9.9g s93 •
TAX MAP NO. : Section /0 / Block 3 Lot . l
CROSS STREET: /-r2p0/QfiS ,i,LT
BUILDING PERMIT NUMBER CROSS REFERENCE:
Snature of Applicant
RECEIVED ( .' . /4
`I"'ownrk's office
DATE: JUN 02 Iga7
Town Clerk Southold
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