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JUDITH T. TERRY �,O Town Hall, 53095 Main Road
TOWN CLERK P.O.P.O. Box 1179
REGISTRAR OF VITAL STATISTICS U' Southold, New York 11971
MARRIAGE OFFICER �� Fax (516) 765-1823
®1 ��®�'����, Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3119-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CASE, GEORGE
Mailing Address 1 P. O. BOX 969
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 3745 NASSAU POINT ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6737
Tax Map No. section 111 .00 block 9 lot 4.001
Cross Street OLD MENHADEN LANE
Date Of Last Pump Out 0/00/00
Issue Date: 9/23/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
°OFFICE OF THE TOWN CLERK 00�FFO
Town of Southold Application No.Z11/
Judith T. Terry, Town Clerk 3�-,,r ;� �.�
, �.�
Town Hall, 53095 Main Road o ,. $10.00 - Residential
P. O. Box 1179 cn � i $25.00 - Non-Residential
Southold, New York 11971 Oho �p�-
Telephone : .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
oa
Fee $
DATE J ,/pf->
OWNER NAME: C.,p,, A -5
OWNER MAILING ADDRESS: Zp 9e 9
i7 , A/W //93S-
.
OWNER PROPER` Y ADDRESS: 33-7 rk 4- 6i,-' % �O i9
b Cs71D'G� /l /l g 3 3
OWNER TELEPHONE NUMBER: 73 % 4 73 `7
TAX MAP NO. : Section / / ( Block C:?. Lot LA (
CROSS STREET: 414,' Dfs4/ 1/(2a, -D
TYPE OF SYSTEM: Septic Tank ✓ New Existing V •
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:. -Jai /f93 (4-4-&-4-5-e- XZ4 X0.4')
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_) --
, Signat a of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
NASSAU POINT HOUSE Septic System Layout
374 fvfs.s-1141 �D✓n/i / 2'
C� C ® 9ilty�
Cellar Small Back Porch
steps of/31,4i41 ;1A)a.-/E
—O 1 I
/17
PiP
6'
4'
Clean every 2 — 3 years off'
7 Last done: July 93 Cover-2'6"
�, f ���I SPE
41 To Large septic Tank
Q down the hill
,aK
7s F��,
61(10/2,0,0
,i09 s