HomeMy WebLinkAboutCuttrell ,itoe.tf Di;
Town Hall, 53095 Main Road
&ft = P.O. Box 1179
® s� ���,+i Southold, New York 11971
JUDITH T.TERRY ®� �a ,i!`,!' TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR Oh VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 847-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner CUTTRELL, GERALD
Mailing Address 1 17 BRIXTON ROAD
Mailing Address 2
City St Zip GARDEN CITY NY 11530-0000
Property Address 1 237 BREAKWATER ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-248-7033
Tax Map No. section 106. 00 block 8 lot 47. 002
Cross Street BREAKWATER ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/19/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'c��FFOC,r�'-
Town of Southold � .h;.,. C0 • Application No."77
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road - I Residential
P. O. Box 1179 to +, Non-Residential
Southold, New York 11971 O
Telephone _ d `�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION•
aor
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
•
DATE
OWNER NAME: C-16/7-7-724 4.--
OWNER MAILING ADDRESS: /7 Ce! X/OV, /9,�?
671W-.0.Meti Cat 77. ivy //s-,9,-,
OWNER PROPERTY ADDRESS: , Z37_/ tre/cG 40,9-7i . /67.
OWNER TELEPHONE NUMBER: 66 - 70,3 3 �•
TAX MAP NO. : Section-/06,-?YZpZBlock Lot •
CROSS STREET: &,77,99-K,
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TYPE OF SYSTEM: Septic Tank New 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.)
• .%%ft;(1, fe.fZ.,
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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