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HomeMy WebLinkAboutDank � ®4A, v � • JUDITH T. TERRY Town Hall, 53095 Main Road TOWN CLERK ® d P.O. Box 1179 REGISTRAR OF VITAL STATISTICS .� Southold, New York 11971 MARRIAGE OFFICER C) et, Fax (516) 765-1823 �®i CS�to ,•!le 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. 3059-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner DANK, LEONARD AND BERYL Mailing Address 1 P. O. BOX 194 Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 SMITH DRIVE NORTH Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-734-6199 Tax Map No. section 76.00 block 2 lot 1 .000 Cross Street WEST CREEK ROAD Date Of Last Pump Out 0/00/00 Issue Date: 7/09/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) • I OFFILE, OF THE TOWN CLERK � Town of Southold , .,�`,„,„% Application No.30 Sf Judith T,. Terry, Town Clerk Town Hall, •,53095 Main Road w° '` 4 1 $10.00 - Residential p. 0, Box 1179 crs ,= �` $25.00 - Non-Residential Southold, New York 11971 Telephone %fr Asl (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE 17/ X P3 OWNER NAME: LED ang-0 f fciL ,3410 f OWNER MAILING ADDRESS: P 9 O1oY / 9i/ c,1NY /f gas OWNER'-PROPERTY ADDRESS: ;%fre 10©12! e-e&—&7 i Svarif-6L-6 i✓y°, OWNER TELEPHONE NUMBER: ����j 7J - 6 19 7 fodo - 76 - — t TAX MAP NO. : Section '' Block 6pAM-Ci r= CROSS STREET: 2':57--pie Re -`x „telk.,nF s , : i``':,: :,'ir,'; *r; r .Sv it :i.«`„ :, c,,�•_,. ;t =. „ ., pE, p,F;,-SYS ,.EM, ,,Se tic' Tahk .'ti';'; _ ;f, °New. ::` X;Existir5 -_ t.. ,-_ M ii 1 - -- •r ,l ate '•''•li,rf,A_ e: •` °•"` :t'fa2��s - - " y `.. Cesepool Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: "f$L-`_d8:-!? •60 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: X' R wn C erk's Office DATE: JUL 9 1943 ft 1 � a ge-�-��� 1 I CO" W I it _o - • �' Js % L✓L /.;01Lr fi