HomeMy WebLinkAboutCaven r: i'z `
, .� , = I� Town Hall, 53095 Main Road
" �� �:�`� P.O. Box 1179
', �� � Southold, New York 11971
JUDITH T.TERRY - ®� l'�' TELEPHONE
TOWN CLERK "'���� (516) 765-1801
REGISTRAR 01 VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 810-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner CAVEN, EDWARD W.
Mailing Address 1 P. O. BOX 664
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 PIKE STREET
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9617
Tax Map No. section 140.00 block 2 lot 21.000
Cross Street LOVE LANE
Date Of Last Pump Out 0/06/87
Issue Date: 9/02/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE rN CLERK
Town �uuthold A ` C'
Town Clerk ��" �` "� `' �G Application No. ��d
Judith T. Terry, ;>
Town Hall, 53095 Main Road " " Residential
P. 0. Box 1179 cn k- r tri •
4 • Non-Residential
kt
Southold, New York 11971 O ®
•
Telephone _01
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
RECENEP
AUG 29 19 ` u OPERATION PERMIT
SEPTIC TANK or CESSPOOL
ton CM Saha
Operation Permit No. /17O
Fee $ 1(;), D )
DATE .1....7/0
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OWNER NAME: ®a� `` � �� )J . t V060
OWNER MAILING ADDRESS: 9® CC
nuvrrrr v u( , L I Q.9 5
OWNER PROPERTY ADDRESS: ® S ,
OWNER TELEPHONE NUMBER: cic'- 6
TAX MAP NO. : Section ki 0 Block Lot
CROSS STREET: Lb J Lias
TYPE OF SYSTEM: Septic Tank New _Existing
Cesspool 160.'" New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: apoi
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.)
1 .N
Signature of Applicant
RECEIVED BY:
REC' :}_ n CI r k's O fic
DATE: S P 02 '°.
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