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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK t P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS rr Southold, New York 11971
��` Fax (516) 765-1823
MARRIAGE OFFICER ® 41.
r 6094ab �/�1�! Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1951-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CARRUBBA, SALLY
Mailing Address 1 WEINER, BUNITA
Mailing Address 2 P. O. BOX 1128
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 55 LANDING ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-4017
Tax Map No. section 111 .00 block 2 lot 5.001
Cross Street HAYWATERS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 7/27/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK oc0FO(,r
Town of Southold .^ CQG• Application No. /
Judith T. Terry, Town Clerk .` r
Town Hall, 53095 Main Roado M r4 \ $10.00 - Residential
P. O. Box 1179 cn � 11
=,'= i �` $25.00 - Non-Residential
Southold, New York 11971 pt $ $
Telephone j •
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(516) 765-1801
TOWN OF SOUTHOLD
_ SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK o(CESSPOOL
Operation PermitNo.
Fee $ 0, 00
DATE 1 LH" 1 9 'a
OWNER NAME: 61r-lLL44 ci\c\e„ ugGiALeto\--rn w el N
OWNER MAILING 'ADDRESS: V1) 4 eO \VD,S 5� LAN% l l\ 4),
OWNER PROPERTY ADDRESS: 5pAi plp,o
OWNER TELEPHONE NUMBER: CS ) 714_ L-1-0 \r?
TAX MAP NO. : Section 1 I \ Block (� d Lot O6S , 00
CROSS STREET: `I •
TYPE 'OF SYSTEM: Septic Tank l New Existing
Cesspool )4. New X Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:_ &c. K,t\ 6Ui J
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.)
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Sig ature of Applicant
RECEIVED-:BY' a..701.2V
own grk's id ffice
DATE: 7/27 t?
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jTHE DIMENSIONS SHOWN HEREON,FROM THE STRUCTURES TO THE PROPERTY LINE ARE FOR A SPECIFIC PURPOSE ONLY. r°,1'
i x THEY ARE NOT INTENDED TO BE USED FOR THE ERECTION OF FENCES,STRUCTURES OR ANY OTHER IMPROVEMENT.; � ► s,, o� ,9 I I-r
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-IN I d TO THE PERSON FOR WHOM THE SURVEY IS PRE• r.;,
!' �� �• UNAUTHORIZED ALTERATIONS COPIES OF THIS SURVEY MAP PARE•,AND ON HIS BEHALF TO THE TITLE COMPANY, s'UFFo e_K. !i'„
" 1 / %•gyp A nn/T+nuC•rn Tyle CtinVFV IC NOT QEA-RING THEcua. ••.n .