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HomeMy WebLinkAboutHarrington ?101\ f Ddb JUDITH T. TERRY Town Hall, 53095 Main Road TOWN CLERK ® P.O. Box 1179 REGISTRAR OF VITAL STATISTICS qP 1 Southold, New York 11971 MARRIAGE OFFICER A Fax (516) 765-1823 _ ,ei r1-11 %% #r 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. 1994-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner HARRINGTON, HELEN E. Mailing Address 1 145 SKIPPERS LANE Mailing Address 2 City St Zip ORIENT NY 11957-0000 Property Address 1 145 SKIPPERS LANE Property Address 2 City St Zip ORIENT NY 11957-0000 Owner Telephone No. 516-323-3647 Tax Map No. section 25.00 block 1 lot 22.000 Cross Street VILLAGE LANE Date Of Last Pump Out 0/00/00 Issue Date: 10/19/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK SVFFO(,(r - /C Town of Southold �� _.r..f CQ • Application No./ Judith T. Terry, Town Clerk �` + ' a 1 $10.00 - Residential Town Hall, 53095 Main Road y .. p. O. Box 1179 cry t :, �+l.611 z $25.00 - Non-Residential O ® Southold, New York 11971 ‘r Telephone "40_* (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE ©cy /4✓ (992_ y OWNER NAME: IA cz_ J �'l��y OWNER MAILING ADDRESS: 14 S'�; pp' o w A, CnrsP NI0:5 , OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: 3 „L "2 — 3 6 '/ TAX MAP NO. : Section . Block Lot CROSS STREET: N(.; TYPE OF SYSTEM: ~Septic Tank New Existing Cesspool ,/ New Existing Residential Non-Residential ^ • DATE OF PREVIOUS PUMP-OUT: c.,t-� t„_) h� / � rS v LOCATION MAP: Must be attached hereto before permit e pe mit may be issued. (Locate building and system; give north arrow and feet of distance, approximately, to building and closest road.) 11 P Signature of Aa,plicant RECEIVED BY: Tow Clerk's Office MOVED DATE: O L o 1. .9199? Town Clerk Soutliokft _,.eta V- r y 7-6