HomeMy WebLinkAboutCase 1. n1"
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Town Hall, 53095 Main Road
00, I P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY „„� r!� 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. 1203-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CASE, HARRY AND MYRA
Mailing Address 1 BOX 760
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 2395 WEST CREEK AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5191
Tax Map No. section 110.00 block 2 lot 8.000
Cross Street DICKS POINT ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 8/03/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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'OFFICE OF THE TOWN CLERK1F0
Town of Southold �� Application No. 423
Judith T. Terry, Town Clerk �t`µ'ms x " '
Town Hall, 53095 Main Road :'� �' $10.00 — Residential
P. O. Box 1179 cryo ,w'Y fix`` hit $25.00‘- Non-Residential
Southold, New York 11971 OO`��`,
Telephone j ��•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE //3/1/4:9
OWNER NAME: y/ +-/V/7J? / I C/57R- •
•
OWNER MAILING ADDRESS: ,2 Y '/,4,S'T �,�/- ,��/�" /5DXXO
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: ✓6' '•7,3 4/ —S7 /I
TAX MAP NO. : Section //O Block Lot r
CROSS STREET: 22/ C ,kc Po/,j(//
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool K New Existing }'
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 6 ji/ ypar
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.)
Si -4
gn ure of App nt
RECEIVED BY:
Town Clerk's Office
DATE:
• //9x/6 d o--//�
MR. HARRY G. CASE
2395 W. CREEK AVENUE
BOX 760
CUTCHOGUE, L.,/1 SI' Y. 11935
A/70
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