HomeMy WebLinkAboutHamilton (2) 14 *siA%
Town Hall, 53095 Main Road
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® ��� P.O. Box 1179
1 ®ii- Southold, New York 11971
JUDITH T.TERRY ,../ ,,� TELEPHONE
TOWN CLERK (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. 642-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner HAMILTON, ROBERT D.
Mailing Address 1 HAMILTON, MARY L.
Mailing Address 2 200 SMITH DRIVE SOUTH
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 200 SMITH DRIVE SOUTH
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5579
Tax Map No. section 76. 00 block 3 lot 31. 000
Cross Street MAIN BAYVIEW ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 3/08/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK Y ' PFFD
Town of Southold �� CQ Application No. 6 K�
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Judith T. Terry, Town Clerk % ,�� � qb`7
Town Hall, 53095 Main Road
� Residential
P. O. Box 1179 .`' Non-Residential
Southold, New York 11971
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Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
fo'r
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE cure_Art w tqsg
OWNER NAME: \D , and/al Roork.1 \—` $ &)r \`
ItAn
OWNER MAILING ADDRESS: .D06 ThOy .
56,- I d w ..\t . kti7 I
OWNER PROPERTY ADDRESS: Geg.im 'e_ _-
OWNER TELEPHONE NUMBER': It, qi,E ' SS i q
TAX MAP NO. : Section '1 le Block 3 Lot 3
CROSS STREET: WR.\ i\ .�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing a�
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.)
\NV.3.A.,u4t, 4(sts\ryd
nature of Applicant
RECEIVED BY: -
Town Clerk's Office
DATE: - :
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