HomeMy WebLinkAboutHarkoff a Town Hall, 53095 Main Road
.v'
- v •�� P.O. Box 1179
----..*2 11, Oso Southold, New York 11971
JUDITH T.TERRY
":"%.......wo/0" 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. 729-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner HARKOFF, DORIS
Mailing Address 1 P.O. BOX 747
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 WELLS ROAD
Property Address 2
City St Zip MATTITUCK NY' 11952-0000
Owner Telephone No. 516-298-8311
Tax Map No. section 126.00 block 8 lot 20. 000
Cross Street ALBO DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 6/08/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERKt°3\\VFOUr
Town of Southold �� Y �®G Application No. 7
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road `4' "4 Residential
P. O. Box 1179 trr �� Non-Residential
Southold, New York 11971 O `0 _`
Telephone ��
�`
� � , .�e
(516) 765-1801
TOWN OF SOUTHOLD
cugic SOUTHOLD WASTEWATER DISPOSAL DISTRICT
MAY 231988
APPLICATION
e for - -
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ l Q;Q°
DATE 67 7
OWNER NAME: Harkoff, Doris
OWNER MAILING ADDRESS: 1/06160X ? 714 -1
P11� c/ (-'L/ II � s�Z-
OWNER PROPERTY ADDRESS: Wells Road if D, /3 b)( 7 Y 7
Mattituck, New York If
OWNER TELEPHONE NUMBER: F — 3 1
TAX MAP NO. : Section 126 Block 8 Lot 20
CROSS STREET: 4 __2'-A l'9 L4'?0 O �L
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool C'L-:5S hU0 New Existing v."-
Residential P7 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.)
Signature dr Applicant
RECEIVED BY: c. r J
l lVE Town Clerk's Office
DATE: jug 081' 'e
Town Cloth Southold