HomeMy WebLinkAboutDawson "Of
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JUDITH T. TERRY
Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �• Southold, New York 11971
MARRIAGE OFFICER
G O " �! Fax (516) 765-1823
e® 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. 1942-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DAWSON, C. AUSTIN
Mailing Address 1 915 CRITTENS LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 915 CRITTENS LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3699
Tax Map No. section 70.00 block 11 lot 3.000
Cross Street PARKWAY
Date Of Last Pump Out 0/00/00
Issue Date: 7/13/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK cOFO(,r•'•
Town of Southold � CQ ; Application No. /9
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Judith T. Terry, Town Clerk �► ,_
Town Hall, 53095 Main Road 's x I $10.00 - Residential
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P. O. Box 1179 v' " _. =4 4:Yri ,` $25.00 - Non-Residential
Southold, New York 11971 O ® #94.:1;
Telephone 'V Ng'6o•
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ Moo
DATE 7//649
OWNER NAME: 4tLS'zi i,) DCW$072
OWNER MAILING ADDRESS: q/5 l ?r,'1in3 La-1/7
�ou.lAt9id rUy ( ( ?7 /
OWNER PROPERTY ADDRESS: •-6ame.-
OWNER TELEPHONE NUMBER: 5i/ t5- q7
TAX MAP NO. : Section '2 6 Block 1/ Lot 3 _
CROSS STREET: (Pa�rkwa
J
TYPE OF SYSTEM: Septic-Tank = - New Existing
Cesspool l/ New Existing V
Residential V 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.)
Signature of Applicant
RECEIVED BY:
- — 1 own Clerk's Office
DATE: 7/ &( -
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Cess Pools
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