HomeMy WebLinkAboutEast Isle Custom Bldrs (2) JUDITH T.TERRY $� Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
PVT 1 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS '4'.0
MARRIAGE OFFICER \�� ® Fax(516)765-1823
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RECORDS MANAGEMENT OFFICER 0.1 1°,00' Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3360-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner EAST ISLE CUSTOM BUILDERS INC.
Mailing Address 1 278 JAMAICA AVENUE
Mailing Address 2
City St Zip MEDFORD NY 11763-0000
Property Address 1 975 OLE JULE LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-727-6023
Tax Map No. section 122.00 block 10 lot 1 .000
Cross Street NEW SUFFOLK AVENUE
Issue Date: 6/28/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK •���FQU( --
Town of Southold �� CQG' Application No. 5,3 66
Judith T. Terry, Town Clerk � $10.00 - Residential
Town Hall, 53095 Main Road •
P. O. Box 1179 tr3 ' , r' ► $25.00 - Non-Residential
Southold, New York 11971 O
Telephone 40.( •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ j 0
DATE CI � ( �
OWNER NAME: Z":---:-/.457- 751.--- S77:5zcce.)45
OWNER MAILING ADDRESS: :2-72. --J/ �.1c4 ('v
,oy
OWNER PROPERTY ADDRESS: 9 7 IS '
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OWNER TELEPHONE NUMBER: 7 Z7
TAX MAP NO. : Section /Z� Block lv Lot
CROSS STREET: A.) 5WFPok(L V[,
TYPE OF SYSTEM: Septic Tank New ✓ Existing
Cesspool New V Existing
• 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.)
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SiF. 0re of Applicant
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RECEIVED BY:
Towri Clerks Office
DATE: (p 4" 0 77
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