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HomeMy WebLinkAboutHagglund JUDITH T. TERRY 3 Wi `` � .-- Town Hall, 53095 Main Road TOWN CLERK g P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER Fax (516) 765-1823 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. 1610-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner HAGGLUND, HUDSON Mailing Address 1 1725 DEEPHOLE DRIVE Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 1725 DEEPHOLE DRIVE Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-8807 Tax Map No. section 115.00 block 14 lot 19.000 Cross Street RIEHARD STREET Date Of Last Pump Out 0/00/00 • Issue Date: 1/17/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) I I/I OFFICE OF THE TOWN CLERK 'c.3\\V (�,�'• '_ Town of Southold � ,.,- ; , Application No. / L9 /.0Judith T. Terry, Town Clerk '; y / Town Hall, 53095 Main Road w �<} - . $10.00 - Residential P. O. Box 1179 cry -'''S $25.00 - Non-Residential �i Southold, New York 11971 OQ;;s,.4' Telephone (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /Y) DATE /2/ 'OWNER NAME: X ` a Lvi ' OWNER MAILING ADDRESS: 1725 )c:l �? c-�L� 2(ZttJL OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: S`t, - Zc - 02)6-1 TAX MAP NO. : Section V‘ Block (- Lot t Ct CROSS STREET: 1, IL&le itsp 5 2�F•i TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing S Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: N(4 e--1 LOCATION MAP: Must be attached hereto before permit may be issued. 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