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HomeMy WebLinkAboutHardy 40.410,010 Town Hall, 53095 Main Road ,��� �' P.O. Box 1179 '_eip-� IS" Southold, New York 11971 JUDITH T.TERRY 7-4k-4A...w,iii" 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. 1293-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner HARDY, BEATRICE Mailing Address 1 P. O. BOX 110A Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 MAIN ROAD Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-5911 Tax Map No. section 115.00 block 2 lot 5.000 Cross Street MARRATOOKA LANE Date Of Last Pump Out 0/00/84 Issue Date: 11/06/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK c�VFFO(,� Town of Southold o CQ Application No. /2.73 Judith T. Terry, Town Clerk .r� Town Hall, 53095 Main Road z� $10.00 - Residential p. 0. Box 1179 �' "' i t40:0 . $25.00 - Non-Residential Southold, New York 11971 O ® ; f Telephone y 0 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. /2,93 Fee $ t.0: 00 DATE 0C+0 f7 6, 4, / I, Vi OWNER NAME: C/4-TA � A D•1 • OWNER MAILING ADDRESS: 1 ° -(4 1 ) d A t-Tt6L,0 / .tz,J. ` ' [ ti`1 C7� OWNER PROPERTY ADDRESS: 1 OWNER TELEPHONE NUMBER: TAX MAP NO. : Section I I Block fL Lot 5 CROSS STREET! 7 6- ,W121.4-- fy14 \ 3 S M A iZ x`©01 /1---L4A/e 99 l TYPE OF SYSTEM: Septic Tank New Existing Cesspool V New Existing Residential ( Non-Residential • DATE OF PREVIOUS PUMP-OUT: ) ° g . (� . 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 Appli ant RECEIVED BY: g_ezxzgc—a.REcevli own ClerkOffice DATE: NOV 03 99b1 Tows Mt* Southold 6 \ .S.N ,,Q -IA 21S 3� p BARN GAR �.; ,,,;,•;; - O l raj i II i 36 SI\ .; ' V. . 1 jzi".5‘-k e 0 . 4. : 1 -------------- . \ > all'Iti) MI : . ( AePR°) ' �� .(�!- I . - QI ✓Ori i-UUS� I *�i !�PPR° �— l o o L N1•1i1 { , r. ' r.-3 \4_ �� C CSS I) (n 7- 1 Pog�.rj 1. - 0 CO V. INI 3 41 - • r5 h,i_ 0 OO' 246,83 i' 4 N.a-7°4 t I