HomeMy WebLinkAboutHaeg JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK l SouP.O. Box 1179
' ` " thold, New York 11971
REGISTRAR OF VITAL STATISTICS ?r; ,
r Fax (516) 765-1823
MARRIAGE OFFICER 'r•`.'-a '` 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. 1602-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HAEG, JOSEPH D. & CHRISTINE B.
Mailing Address 1 2795 BAY AVENUE, RR 2
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 2795 BAY AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4117
Tax Map No. section 144.00 block, 5 lot 2.000
Cross Street SALT LAKE LANE (ROCHELLE PL)
Date Of Last Pump Out. 0/00/00
Issue Date: 1/17/91 Judith T. Terry_
Southold Town Clerk
(TOWN SEAL)
OFFICE OF' THE TOWN CLERK c�vFFO/A- ,
Town of Southold off® - CQ ' Application No.
Judith T. Terry, Town Clerk sritY , y
e $10.00 - Residential
Town Hall, 53095 Main Road =? -
P. O. Box 1179 u' ` i � $25.00 - Non-Residential
Southold, New York 11971 O ®
Telephone (44.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. -
Fee $ •
DATE 4C-L, , 7770
OWNER NAME: ;e9-4 :P/ 4 S%/ C•
OWNER MAILING ADDRESS: A77S /942/ •-"CX-,
M/9-777 Zc/c ,iJ - //9
OWNER PROPERTY ADDRESS: Si' it
OWNER TELEPHONE NUMBER: 6-76 cr' X7/7
TAX MAP NO. : Section P71:-LA Block Lot
CROSS STREET: X4-4 x1c /°i e ( ci —Z -
TYPE
OF SYSTEM: Septic Tank New Existing 8�
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ' ' ; / 9?"
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.)
ignature of ApO, -.nt
RECEIVED BY: k,
Town Clerk's Office
RECEIVED
DATE:
DEC 1.- 'y
Town Cleric Southold
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