HomeMy WebLinkAboutCutler JUDITH T.TERRY t0 "04: -� • Town Hall, 53095 Main Road
TOWN CLERK ® ,�
P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS € :
MARRIAGE OFFICER : ° ®�_ ilk Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER , �,� �� Telephone(516) 765-1800
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FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3749-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner CUTLER, GARRETT
Mailing Address 1 P. O. BOX 1757
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 784 BAILIE BEACH ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-3530
Tax Map No. section 99.00 block 3 lot 6.000
Cross Street
Issue Date: 12/22/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
Or FICA OF •THE TOWN CLERK c0FUtii/'=
Town of Southold0k
, % CQApplication No. c�
Judith T. Terry, Town Clerk G; . }}
Town Hall, 53095 Main Road $10.00 - Residential %,rrb
P. O.• Box 1179 cry $25.00 - Non-Residential
Southold, New York 11971OO .{'
Telephone : .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE a.- 0.N-Vic
OWNER NAME: Ccr v-<,Ai <-- C,t1e.t~
OWNER MAILING ADDRESS: %o`F
OWNER PROPERTY ADDRESS: '4ZS`k 9akk, A.,„ �0 -
n.ei.i'c \c uv "c)-t.
OWNER TELEPHONE NUMBER: 1-"06 "..5 5-56
TAX MAP NO. : Section Block L.5 Lot i="2
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing /
Cesspool New Existing
Residential Non-Residential
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: