HomeMy WebLinkAboutHamilton his 0101
girtr Town Hall, 53095 Main Road
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N- .•% P.O. Box 1179
a; 'N� ��� Southold, New York 11971
JUDITH T.TERRY = ���� FAX(516)765-1823
���� TELEPHONE(516)765-1801
TOWN CLERK
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. 1200-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HAMILTON, MARY T.
Mailing Address 1 P. O. BOX 588
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 520 PEQUASH AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6804
Tax Map No. section 103.00 block 11 lot 2.000
Cross Street FIRST STREET
Date Of Last Pump Out 0/00/00
Issue Date: 8/01/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
iy
OFFICE OF THE TOWN CLERK �S�FFULA-
Town of Southold �� �.. c CSG', Application No.490 G
Judith T. Terry, Town Clerk . a1''- x•
� ���� w°�4, ` '-' $10.00 - Residential
Town Hall, 53095 Main Road t{ ;'�
P. O. Box 1179 c' x'0j� i
� � s+...�,,,,�, $25.00 - Non-Residential
Southold, New York 11971 O e.*;CA'.;?
Telephone '1* T •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: /7/MjPyiI/`'jJ,L,�IS 4/
OWNER MAILING ADDRESS: PO 46X 8O
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OWNER PROPERTY ADDRESS: Lj p2O 4- ef,,A5' A/
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OWNER TELEPHONE NUMBER: // 7J/ -/:78.0 /
TAX MAP NO. : Section 10 C? Block /l Lot
CROSS STREET: /17/(,'6 / �/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool tf New Existing
Residential 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.)
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�ignature of Applicant
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RECEIVED BY: WA).
own Clerk's Office
DATE: � q
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