HomeMy WebLinkAboutEdson (2) 0,,00c,��FfWired;G___
ri‘',' Town Hall, 53095 Main Road
s/ P.O. Box 1179
`��®•' Southold, New York 11971
JUDITH T.TERRY FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
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. 1538-R Residential X Non-Residential
Fee $ 1Q.00 Septic Cesspool X
New Existing X
Name Of Owner EDSON, LEWIS
Mailing Address 1 P. O. BOX 1506
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 MAPLE LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2288
Tax Map No. section 64.00 block 1 lot 24.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 10/02/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
' ` /I III
OFFICE OF THE TOWN CLERK •CSFI(e --
Tow n
-Town of Southold 4 CQG' Application No. /53Z
Judith T. Terry, Town Clerk :)
Town Hall, 53095 Main Road -, = , ,1 $10.00 - Residential
�' 1
>e'.L +1i,
P. O. Box 1179 cn = `
$25.00 - Non-Residential
Southold, New York 11971 O "O �►`
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Telephone _ j ,6o
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /6
•
DATE 74.5-4-d
'OWNER NAME: J 6=4v $ I )S 1/L '
OWNER MAILING ADDRESS: �� / ✓`� 6
OWNER PROPERTY ADDRESS: jrj• ?/� ,42e7
OWNER TELEPHONE NUMBER: 7, , 5 2- Z F
TAX MAP NO. : Section 6 7 Block f Lot
CROSS STREET: j ,4'/ft/ ,o• ' 746
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential k- 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.)
,001.111.
• 11111
'ignature of Applicant
RECEIVED BY: 4
Tow Clerks Office
-DAT-E: