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Town Hall, 53095 Main Road
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Southold, New York 11971
JUDITH T.TERRY s°ooI FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 983-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BROWN, PHILIP
Mailing Address 1 LOONEY, M.F.
Mailing Address 2 P. O. BOX 777
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 ROUTE 48
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7353
Tax Map No. section 84.00 block 5 lot 2.000
Cross Street BRIDGE LANE
Date Of Last Pump Out 0/00/00
Issue Date: 1/09/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK saFU
Town of Southold C A lication No.
Judith T. Terry, Town Clerk % �� " - % pp
Town Hall, 53095 Main Road_ E.-,, ' Residential
P. 0. Box 1179 to s?^' 't•1•- '? i
c• ;'r ;' Non-Residential
Southold, New York 11971 O . �/t` _
449hTelephone, -- , - - - - : .c-
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL .
Operation Permit No. Q LJ
Fee $ •
DATE /AIR7 hyy
OWNER NAME: Tt f/k l ia ElQ O GJ A/ im -- ilif• F L O ONc y
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OWNER MAILING ADDRESS: P. /D. i.3o( 717
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OWNER PROPERTY ADDRESS: pov7,, 711 //'9.35'
CurcHoc
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OWNER TELEPHONE NUMBER: 4"/6- 731-- 7353
TAX MAP NO. : Section Sit. Block —S Lot --
CROSS STREET: ,82/ 046 X.ic1h/E
TYPE- OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,DoZ r ,CAJote) .
- 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.)
C.---iall2 7ra'?:;:43
Signature of Applican
RECEIVED BY: -
Town Clerk's Office ' .
DATE:
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SURVEY FOR.' P1'/IMP ,5I�O&N 9- M.F &OONREFy ERENCE: .-
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AT PECONIC - •
1014/N OF SOUTHOLD GUARANTEED TO:
SW-FOLK COUNTY N.Y. INTER•COUNrYTITLE GUARANNTY9MORTGAGE.CO.
' JOSEPH aROSE MARIE PIEGYE's.
SCALE ' 1" - 40' •
OCT 20, 1969
.
LAND SURVEYOR
' N.Y.S. LIC.NO.28725
: _ RI VERHEAD, N.Y. ` -
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