HomeMy WebLinkAboutDavis (2) 00
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,; Town Hall, 53095 Main Road
.-4 `' P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY ` , o'' FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 990-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DAVIS, CLAUDE E.
Mailing Address 1 P. O. BOX 17
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 OLE JULE LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8444
Tax Map No. section 122.00 block 4 lot 4.000
Cross Street NEW SUFFOLK AVENUE
Date Of Last Pump Out 10/00/87
Issue Date: 1/11/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK
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Town of Southold C Application No.
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Judith T. Terry, Town Clerk '
53095 Main Road 1 Residential
Town Hall, � � 1;
P. O. Box 1179 �' , _ 'AA. t ; Non-Residential
Southold, New York 11971 O ® - ' �•°°
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 1.d d
DATE 7 k `lA7(
OWNER NAME: e I P_ E . ) a u i s
OWNER MAILING ADDRESS: U 60
OWNER PROPERTY ADDRESS: U le_ Nif L P n
IA OA,* tA /1 Cl (L.--
OWNER TELEPHONE NUMBER: c› 9 y.1 cri/ 3
1 .ZZ . �.�.
TAX MAP NO. : Section Block Lot
CROSS STREET: e w S(44o ( k p,u,_
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool L/ New Existing
Residential on-Residential
DATE OF PREVIOUS PUMP-OUT: /6) 0
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 Ap li ant
RECEIVED BY: 1Y}c-ce..-
Town CI rk's Office
DATE: / — /(-
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