HomeMy WebLinkAboutEdeen .? r oeiroi r0 0400.27,,
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK
(1 ;3
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS H .�` Southold, New York 11971
e O 4 Fax (516) 765-1823
MARRIAGE OFFICER ® .4
V410 ! Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1911-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner EDEEN, RONALD J.
Mailing Address 1 P. O. BOX 335
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 11405 MAIN ROAD
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-1541 f
3
Tax Map No. section 31 .00 block 4 lot „.3•2<)00
Cross Street TRUMAN PATH
Date Of Last Pump Out 0/00/82
Issue Date: 5/28/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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6FFICE OF THE TOWN CLERK c0FO(,, '•
Town of Southold �� CQ Application No. / ?/ (
Judith T. Terry, Town Clerk , `1 $10.00 - Residential
Town Hall, 53095 Main Road �� ;
p. O. Box 1179 x "ifh ' .`` $25.00 - Non-Residential
Southold, New York 11971 O3`o" • $
Telephone -70 4 '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /ff
Fee $ l6 i
DATE .6oAG19A
OWNER NAME: R8 11~) \k EPEE-At
OWNER MAILING ADDRESS: p®. aaG /14O6 1/J1/41 a>.
045T,%v fog )V , 1/937
OWNER PROPERTY ADDRESS:_ J/g011 4J4/1j b -
y
OWNER TELEPHONE NUMBER: 676 — 1-1/7/7- 8-4 1
TAX MAP NO. : Section / Block 17" Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing ,<
Cesspool New Existing
Residential . Non-Residential
DATE OF PREVIOUS PUMP-OUT: 4PpiQQx% i'9,s3Q
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.)
42— at7
Signatur o Applicant
RECEIVED BY: /1)Z /
Town Clerk's Office -
DATE: 3-76_
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