HomeMy WebLinkAboutHamid 1,54
,�., Town Hall, 53095 Main Road
40" P.O. Box 1179
�� !� Southold, New York 11971
111
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. 1429-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HAMID, ESMOND W. AND LILLIAN
Mailing Address 1 P. O. BOX 994
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5615
Tax Map No. section 102.00 block 2 lot 18.000
Cross Street STILLWATER AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 3/28/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
. ,,.
OFFICE OF THE TOWN CLERK � .\\V
Town of Southold % C' Application No.
Judith T. Terry, Town Clerk % o.. -44 s* ` y^ I $10.00 - Residential
Town Hall, 53095 Main Road a ;{.
n , y
.
P. O. Box 1179 c� � ; ..j, • $25.00 -.Non-Residential
Southold, New York 11971 O `® .;; o��`
Telephone *Q1 . % 't
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
• SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 3P' ZSI' 90
'OWNER NAME: tneln A`:` A . 4• /lsmk)
•
OWNER MAILING ADDRESS: no 60 IN C`faO ll
• .
//f35 .
OWNER PROPERTY ADDRESS:140,404,0
OWNER TELEPHONE NUMBER: 5,/4 73y5t 'r
TAX MAP NO. : Section Block Lot
CROSS STREET:
TYPE OF SYSTEM: .Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: jel
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.)
Signature of Applican
RECEIVED BY: _ _
Town Clerk's Office
DATE:
Ullian melville hamib
�, _
3
pap, w,up r_,v_ _ _ , — ft
41 .___ \ \
i \ _.__pci8 )
J
-43
d
d