HomeMy WebLinkAboutHardman 00
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JUDITH T. TERRY A
Town Hall, 53095 Main Road
TOWN CLERK ` ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS tr/ +" �` 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. 1905-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HARDMAN, KATHLEEN
Mailing Address 1 135 THIRD STREET, UNIT 25
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 160 SUNNYSIDE ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1320
Tax Map No. section 63.00 block 1 lot 7.000
Cross Street HORTON'S LANE
Date Of Last Pump Out 0/00/00
Issue Date: 5/18/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK if
Town of Southold �VFF�(�'C'
.' OG Application No. /Y0
Judith T. Terry, Town "Clerk' - --.-V --� � y
~ `���= ' .�a�} �C I $10.00 - Residential c_----
Town
Hall, 53095 Main Road , , .
P. O. Box 1179 crl :ti, ; r
� �; � ��,s_. �% $25.00 - Non-Residential
O
Southold, New York 11971 ® - . -
Telephone . 01 %tt
(516) 765-1801
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION .
for
• - OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
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DATE ,'- 1 % - 9a-1 _
,
'OWNER NAME: �`
" V I `ems Y\ V"I y(�\ may\ .
OWNER MAILING, ADDRESS: Lk6a 31aph
Cr y I(3n 76Z 1`
OWNER PROPERTY ADDRESS: 1 (p 6 , ' O v n k cl,e_
(3.A. '
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N Ho --7 /
OWNER TELEPHONE NUMBER: 5 (rl 5 36
TAX MAP NO. : Section (la Block I Lot 7 '
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool z\(-- New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 5 - I 1 - 1 ( .
LOCATION MAP: Must be attached hereto before permit may be issued. M
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
171\)cs / ; ,,,,,
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Signatu - of Applicant
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RECEIVED BY: %0Gua_.1..,... ,•uvn Clerk'sice
DATE: ,S / ,
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