HomeMy WebLinkAboutHicks (2) eir
JUDITH T. TERRY �, Town Hall, 53095 Main Road
TOWN CLERK ® u- P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .� Southold, New York 11971
`.
MARRIAGE OFFICER VO). �� Fax (516) 765-1823
66 �® ! Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1945-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HICKS, ROBERT AND JOAN
Mailing Address 1 1275 LANDS END ROAD
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 1275 LANDS END ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-3888
Tax Map No. section 15.00 block 9 lot 1 .019
Cross Street LATHAM LANE
Date Of Last Pump Out 0/00/00
Issue Date: 7/17/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I
OFFICE OF THE TOWN CLERK
.0
OFFICE
Town of Southold Q ��
Q Application No.
•
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road • $10.00 - Residential
P. O. Box 1179 v' 3 r' $25.00 - Non-Residential
Southold, New York 11971 O CI* r ' • $
Telephone Telephoneo�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0e%)
DATE
DATE 7/07--
Y
OWNER NAME: ,Fdsi3e„e j 612;nv )44 ci
OWNER MAILING ADDRESS: /cQ 7$ 2Riv9s
4P/EA/% A// 1/rr7
OWNER PROPERTY ADDRESS: f�,,F-
OWNER TELEPHONE NUMBER: 57d 3,23- 3rd
TAX MAP NO. : Section 6'165 Block Lot Alf
CROSS STREET: 41-7-/W7W %,9j
TYPE' OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ("de e)dr) 6//41,3
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.)
•t7/40Z ,
Signat. -- .1 Applicant
RE,CEIVED•BY:
Town Clerk's Office
DATE:
„Ira
e��� ',any
BOB HICKS
-t77
/a 7r
, /7A/z)
ose
3t, a 5.T
LVS c.P.