HomeMy WebLinkAboutHeacock fie 7
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u1 Town Hall, 53095 Main Road
P.O. Box 1179
_ s� 4te Southold, New York 11971
JUDITH T.TERRY r` ®`��„ ���/ 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. 1249-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HEACOCK, EUGENE AND LOIS
Mailing Address 1 355 CEDAR BEACH ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 355 CEDAR BEACH ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5279
Tax Map No. section 93.00 block 1 lot 6.000
Cross Street PARADISE POINT ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/25/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold ������
� -- CQG• Application No�a'�/�
Judith T. Terry, Town Clerk f y
Town Hall, 53095 Main Road ~ x A.10.00 - Residential
P. 0. Box 1179 MR. $25.00 - Non-Residential
Southold, New York 11971 OIr. sem=;
Telephone _0141NIIU �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
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APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
- Operation Permit No.
Fee $ .M
DATE ;' ;'
OWNER NAME:
OWNER MAILING ADDRESS: 11/\"--
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OWNER PROPERTY ADDRESS: / 1 / ' r
OWNER TELEPHONE NUMBER: 67-1-4
TAX MAP NO. : Section Block / Lot 612
CROSS STREET: i76aP- la
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ej -'
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.lture o Applicant
RECEIVED BY:
alcimffSDClerk's Office
DATE: SEP 191
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