HomeMy WebLinkAboutDejesus '/i sp ®�-•jam.
Town Hall, 53095 Main Road
. � P.O. Box 1179
so Southold, New York 11971
JUDITH T.TERRY % 11";
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TELEPHONE(516)7651801
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. 1187-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner DEJESUS, BENIGNO 8 DOROTHY
Mailing Address 1 806 LINNET STREET
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 806 LINNET STREET
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-2076
Tax Map No. section 48.00 block 2 lot 38.000
Cross Street SEVENTH STREET
Date Of Last Pump Out 0/00/85
Issue Date: 7/19/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
P
._
OFFICE OF THE TOWN CLERK �C�VFQU. --
Town of Southold C' Application No. / 8'7
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Judith T. Terry, Town Clerk % tmoi% $10.00 - Reessidential
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53095 Main Road ' -<
Town Hall,
P. O. Box 1179 Lr3 ;. i $25.00 - Non-Residential
Southold, New York 11971 O ®„ r 0*.$
Telephone411%
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
J �
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE el v
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OWNER NAME: !:jEA 1 (;. 1\1 '..4 \), R nyly O', ' �`t u
OWNER MAILING ADDRESS: ' 0 1v i KIN fl
OWNER PROPERTY ADDRESS: ' Q tp N �
OWNER TELEPHONE NUMBER: .� ! - ° o
TAX MAP NO. : Section 'jf Block Lot 63 f
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CROSS STREET: �� /d7L
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing
Residential y Non-Residential
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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.)
i� ze/nft,* *"_,0 i/AY
5,7:nature of A ' an
RECEIVED BY: /11
Town Clerk's Office
DATE: L7
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