HomeMy WebLinkAboutBates .601'(\fl4e).\\ Hr 0;1-"-
Town Hall, 53095 Main Road
P.O. Box 1179
_ ®4244 , ® so Southold, New York 11971
JUDITH T.TERRY FAX FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1743-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BATES, GEORGE AND OTHERS
Mailing Address 1 BOX 451
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 MIDDLE ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6645
Tax Map No. section 101 .00 block 1 lot 18.000
Cross Street ALVAH'S LANE
Date Of Last Pump Out 0/00/00
Issue Date: 9/04/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
-
VFFICE OF THE TOWN CLERK cvFFO(,r '=
Town of Southold �� �:f• CS • Application No.
Judith T. Terry, Town Clerk 1,j i
Town Hall, 53095 Main Road « zn, .•G $10.00 - Residential
P. O. Box 1179 .:_. trIca#r �; $25.00 - Non-Residential
Southold, New York 11971 ho, Or./
Telephone 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION R E C E I V E D
'
for ti � _ SEP 03 1991
OPERATION PERMIT Southold Town aerk
SEPTIC TANK or CESSPOOL
Operation Permit No. /2(3
Fee $ 00
Crow £J?r DATE .
OWNER NAME: JEs/./ ► ri' Q571j11014s IV f ,1� 'AoU4J
OWNER MAILING ADDRESS: !141,7, 1-
gex 4,5-/ zip tis
OWNER PROPERTY ADDRFSS•-Sf FI fi,S /,67,e, V[
OWNER TELEPHONE NUMBER: 7 9 _
TAX MAP NO. : Section 0 / Block / Lot /492
/0 (
CROSS STREET:
TYPE OF SYSTEM: Septic Tank _ New Existing
Cesspool A New Existing ' 4
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7/ 3/77/
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.)
*7-7 -c/._16Z°
Signature of Applicant
RECEIVED BY:
flown Clerk's Office
DATE: 9-`3 --7/
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