HomeMy WebLinkAboutHardy (2) 'L,
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Town Hall, 53095 Main Road
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® -;�' � �,�� P.O. Box 1179
®d '' 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. 702-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner HARDY, JANIE E.
Mailing Address 1 P.O. BOX 1044
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 BEACHWOOD LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2505
Tax Map No. section 70.00 block 11 lot 21. 000
Cross Street PARKWAY
Date Of Last Pump Out 1/00/75
Issue Date,: 5/13/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK '�,�rb(�.
Town of Southold �� ,„,,,-..c,C ' Application No. 70
Judith T. Terry, Town Clerk
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53095 Main Road c ' '4A' :4 1 Residential 4.
Town Hall, ?mss
P. O. Box 1179 cn ,: z' Non-Residential
Southold, New York 11971 O ®v -3 ' , kr$
Telephone 41°1 '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /O,•00
DATE, 7427 /6i/ffg?
OWNER NAME: J ,�� ,L ( / T 'i j '/4,4,4G i a)
OWNER MAILING ADDRESS: 44 'l,,aj ;..,i,> ,94'40/VqVile7411z4 fitteW1214 74
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: .9 a-' Th��'aoJ�
1 TAX MAP NO. : Section .7v Block // Lot /
CROSS STREET: PA �k w of Lc
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential ;� Non-Residential
DATE OF PREVIOUS PUMP-OUT: /?75
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.)
_` ,4'21-2-1X'• ' 'i .
Signature of Apv licant
RECEIVED BY:
RECO Town Clerk's Office
DATE: MAY 1319: •
Tonna Ctetli Southold
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