HomeMy WebLinkAboutChute OFFICE OF THE TOWN CLERK cOFU(/I(`,"
Town of Southold ,, �Oa �y
Judith T. Terry, Town Clerk . .
Town Hall, 53095 Main Road a t , }"
P. O. Box 1179 ,stn , . .
Southold, New York 11971
Telephone ( zit
(516) 765-1801 _ R
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 299 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
NAME OF OWNER: James E. Chute
OWNER MAILING ADDRESS: 9 Middleton Road
Greenport, New York 11944
OWNER PROPERTY ADDRESS: 9 Middleton Road •
Greenport, New York
OWNER TELEPHONE NUMBER: 516-477-2564
TAX MAP NO. : Section 40 Block 5 Lot 3
CROSS STREET: Route 48
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: Unknown
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Judith T. Terry
'Southold Town Clerk
DATE: May 5, 1987
(TOWN SEAL)
SIP ow.
OFFICE OF THE TOWN CLERK �FFO 7
Town of Southold ®�r. CQG Application No C 2n
Judith T. Terry, Town Clerk .` e ''
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Town Hall, 53095 Main Road Residential .i
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P. O. Box 1179 �‘' Non-Residential
Southold, New York 11971 O `� *-�.
Telephone ®.( •No
(516) 765-1801
RE- . 4VE® TOWN OF SOUTHOLD
APR 1.4 1907 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Town Clerk Southold
APPLICATION
for
�v�
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0 . O C.)
DATE —10 - 8-7
OWNER NAME: 0--ra2)() ( ,
OWNER MAILING DRESS: 9
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OWNER PROPERTY ADDRESS: , i- 1
OWNER TELEPHONE NUMBER: �� - t;2-560
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TAX MAP NO. : Section 4(, Block 5 Lot 3
CROSS STREET: y S
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 7 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.)
/°;;;-,-,P
ignature of Applicant
RECEIVED BY: -_
Town Clerk's Office
RECaVED
DATE: d
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Town Clerk Southold
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`TO THIS"SUVEY'•IS A VICRATION OF -r '
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6 SECTION 7209 OF THE NEW Y,.,nl: s1ATE _
1 EDUCATION LAW. j}
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{ THE LAND SURVEYOR'S INK�U SEAL OR !f'/ .� _ .,,,,, .__
ttt EMBOSSED SEAL SHALL NOT BE CONSIDERED f Adn jll1�7Lral,'�49 -' dd tke Cor' Ftot'Iwec t'
TO BE A VALID TRU COPY.
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GUARANTEES iNQICAI ^,EO, ' ,,-.:
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IS PREPARED, AND ON H' HALF TO THE y� '
TITLE COMPANY, GOV_; ,...1AL AGLNCY AND ' '' 'S{ c ' I'' .0ff1
FENDING INSTIT!I;i L.JIw HEREON,AND • J •
TO THE ASS C• .2..5 OF THE LENDING INSTI. ( �`• ( 1
ZUTIO,; GUARANTEES ARE NOT TRANSFERAEL-E If q �5 •SI e..4Y _
TO ADDITIONAL INSTITUTIONS'OR SUBSEQUENT'1 .G/��+� V1' �'� �{�/ �°Y.,.'
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