HomeMy WebLinkAboutCutchogue Presbyterian Church (2) UL if
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® �� Town Hall, 53095 Main Road
JUDITH T. TERRY ' ° '�.
TOWN CLERK ® ' f P O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER V Fax (516) 765-1823
- W, ' Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1990-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CUTCHOGUE PRESBYTERIAN CHURCH
Mailing Address 1 P. O. BOX 964
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 27415 MAIN ROAD
Property Address 2 (HOUSE EAST OF CHURCH)
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 102.00 block 1 lot 12.000
Cross Street HIGHLAND ROAD
Date Of Last Pump Out ' 0/00/00
Issue Date: 10/15/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c3IFO� -
Town of Southold � "".T 11Q Application No.
Judith T. Terry, Town Clerk - Residential '
p/
Town Hall, 53095 Main Road o - `
P. 0. Box 1179ss. �� $25.00 - Non-Residential
Southold, New York 11971 O ® '?i" *-$
Telephone
Telephone _0 `a0
j ' `
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE /0// /9: /-
OWNER
0// 9 /OWNER NAME: • L' I
OWNER MAILING ADDRESS: � 1 /42k e)-#A,4n
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section i o Z Block f Lot 17
' CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
/
Cesspool ✓ New Existing V
Residential (. Non-Residential
DATE OF PREVIOUS PUMP-OUT: /1(14
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.)
401Si tur �.f Applicant
RECEIVED .BY:
Town erk's Offic -- -
DATE: /0 - / " I
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