HomeMy WebLinkAboutBedell (2) E
r = t ii•
tlfg . � � • Town Hall, 53095 Main Road
V ;'`' tr ;� P.O. Box 1179
�;'� Southold, New York 11971
JUDITH T.TERRY `=a:�,,,� %��� 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. 1522-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BEDELL, JOHN
Mailing Address 1 36225 MAIN ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 36225 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7983
Tax Map No. section 97.00 block 1 lot 25.001
Cross Street BRIDGE LANE
Date Of Last Pump Out 0/00/00
Issue Date: 8/28/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
;y. III
OFFICE OF THE TOWN CLERK S0FOUK
Town of Southold PP
A lication No. ,/9,-5—c=2Olj
Judith T. Terry, Town Clerk f�;` y
Town Hall, 53095 Main Road �;, :°� $10.00 - Residential
P. O. Box 1179 toz � "fY ' `
:� � $25.00 - Non-Residential
Southold, New York 11971
Telephone O. ,�•
(-516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ (0 .•00
DATE -bra-3rd
'OWNER NAME: f-T(9111R•
P� � •
OWNER MAILING ADDRESS: (vf R-o j
C_viC. t-(oGue O ( \�i3,�
OWNER PROPERTY ADDRESS: (v)(4(AI [C
CD Jc� � P (S 3..5-
OWNER
SOWNER TELEPHONE NUMBER: ( 5c-b�
TAX MAP NO. : Section Block I Lot `015, 1
CROSS STREET: C k0Ge: L �
TYPE OF SYSTEM: Septic Tank / New Existing V
Cesspool New Existing
Residential / Non-Residential
DATE OF PREVIOUS PUMP-OUT: U -r}ot.Jr
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.)
it ...ure of Applicant
AUG 2 8 19 „1
RECEIVED BY:
T'owliiI"a terk's Office
DATE:
r v
DO i., TFo ,e0#0 �F`'s., goo \�
�� er 3 /
0 \aq 'oo• \6�.� //
/ i
5 O \/k60.
.spm s O o, a;®� ®�,
p ;0R:1® 0
ON .y20• 03 r
<JS r 03
A
25`�ri,k co
5.
a1' 'oo,\\1 /
/ NNNNN . . ,
40 ,
560:
41, SURVEY FOR
�* COUNTY OF .SUFF(
DEPARTMENT OF REAL ES
"7777,7-
Ar --- TOWN OF _
SUFFOLK COUNTY, NEW F
goo
SCALE IN FEET-
= 100°
GUARANTEED TO:
CMCAGO T/TLE /NSURANCE COMi ANY
COUNTY OF SUFFOL K
��'� 1r
•nAUIHQ11LiO ALTERATION 01�ADOIT1On �'1 '�/!1 /��/ .
17 THIS SLIRVIT IL A VIOIJ�TION OI .!I i-L%- r��