HomeMy WebLinkAboutHatfield Orr
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Town Hall 53095 Main Road
citov ,4 P.O. Box 1179
0006' Southold, New York 11971
JUDITH T.TERRY = l��� FAX(516)765-1823
�� TELEPHONE(516)765-1801
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. 1034-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HATFIELD, JOAN C.
Mailing Address 1 395 HOLDEN AVENUE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 395 HOLDEN AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734I-5525
Tax Map No. section 103.00 block 13 lot 31 .000
Cross. Street NORTH CROSS
Date Of Last Pump Out 0/00/00
Issue Date: 2/28/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �►vFfi�t7(K
Town of Southold �, r CQG'� Application No. /034
Judith T. Terry, Town Clerk -• •
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Town Hall, 53095 Main Road a ; "w'°� }^ '< Residential ✓
O. � t 3'` ;t `
P. Box 1179 cn ���. -; � Non-Residential
Southold, New York 11971 �.� } O�•�`�
Telephone ''��e/
(516) 765-1801
TOWN OF SOUTHOLD
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FE ® 199 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
1kj == zorde, APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
,Operation Permit Nold 3`V
Fee $ 6 d
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OWNER NAME: (7 PC G PfrP r e Lo
OWNER MAILING ADDRESS: t-Sclb ickt
q-y 1\935-
OWNER PROPERTY ADDRESS: -6 (-c Lr) Et t R11\)�
OWNER TELEPHONE NUMBER: 7 %141-
a 4 15
TAX MAP NO. : Section —3 Block I S Lot 3 ( •
CROSS STREET: r) h55
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 1 New Existing I/
Residential C/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: L[ 91r7
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.)
Si•natur\ Applic•T '
RECEIVED BY: AA ( �
own Clerk's/Office
DATE:
FEB 281989-
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