HomeMy WebLinkAboutHarrington ittce
J
y }'t y , 1'
: ; ;`� ��1 Town Hall, 53095 Main Road
`' P.O. Box 1179
'if
FAX
Southold, New York 11971
JUDITH T.TERRY 765-1823
TELEPHONE(16)7654801
TOWN CLERK
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. 978-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HARRINGTON, ROBERT & BARBARA
Mailing Address 1 P. O. BOX 235
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1365
Tax Map No. section 63.00 block 5 lot 11 .001
Cross Street HORTON'S LANE
Date Of Last Pump Out 0/00/75
Issue Date: 1/09/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• ...
OFFICE OF THE TOWN CLERK cvFFO(,(�'=
Town of Southold � ,. C'0 Application No. 9i-�
Judith T. Terry, Town Clerk �� �4�x fr
Town Hall, 53095 Main Road , -4 7 Residential
P. Box 1179 n' < „ ��`
O. i�;' Non-Residential
Southold, New York 11971 O � �`
Telephone = j `�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE // y 3 --W-
OWNER NAME: g&tc.,,t"
OWNER MAILING ADDRESS: e‹)0 ,64.5/ (98,r-
OWNER PROPERTY ADDRESS: ?eti-ef "
' OWNER TELEPHONE NUMBER: kr-/‘ ^?(o or-136r-
, TAX MAP NO. : Section (P 3 Block 5- Lot //,
CROSS STREET: ,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing t/
Residential l0 Non-Residential
DATE OF PREVIOUS PUMP-OUT: / 3 N -o
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.)
• I
Signature of Applicafi
RECEIVED BY:
own Clerk's Office
DATE: I //A
atr
-_~
��
-_.
^^^ �