HomeMy WebLinkAboutCassel t
JUDITH T. TERRY : 4t. Town Hall, 53095 Main Road
TOWN CLERK ® ; P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
.,. .r Fax (516) 765-1823
MARRIAGE OFFICER _- Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER = 1
FREEDOM OF INFORMATION OFFICER �� �t'rz�'��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3214-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner CASSEL, JAMES AND CAROL
Mailing Address 1 233 PRIVATE ROAD
Mailing Address 2
City St Zip EAST PATCHOGUE NY 11772-0000
Property Address 1 WILLOW POINT ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-289-9351
Tax Map No. section 56.00 block 5 lot 40.000
Cross Street BAY HOME ROAD
Issue Date: 6/07/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
r t
,E OF THE TOWN CLERK •• FO
Town of Southold �o CQ Application No.302.1
Judith T. Terry, Town Clerkat.' '`
Town Hall, 53095 Main Road t 4 I $10.00 - Residential c/
p. O. Box 1179
� � �`� `� -�� � i $25.00 - Non-Residential
Southold, New York 11971 O O • i•
Telephone = j *
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPQOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: f'J ,�.�J
eet_4-e_a
OWNER MAILING ADDRESS:
'33 VAAAP-o,L7Z—c.)
/ 7 )
-_OWNER PROPERTY ADDRESS: k11.4,a0-1J
2> 1
OWNER TELEPHONE NUMBER: < 7 to-' '�.�- 93/
TAX MAP NO. : Section ch Block Lot
CROSS STREET: /4/4-A1,-
•
--• TYPE OF SYSTEM: -Septic Tank j/- _New f/ Existing
Cesspool ✓ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
Signature of Applicant
•
RECEIVED BY: . -. _ _
Town Clerk's Office
DATE:
1►
I
•
\co-_ _
,L/L
0—
Sts
\561