HomeMy WebLinkAboutHiggins (3) EAre
Town Hall, 53095 Main Road
�i� P.O. Box 1179
k4�® ®�i Southold,New York 11971
JUDITH T.TERRY 11 eo®� 1? = TELEPHONE
TOWN CLERK vi^•c..��� (516)765-1801
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. 3673-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HIGGINS, MAUREEN
Mailing Address 1 37-05 221ST STREET
Mailing Address 2
City St Zip BAYSIDE NY 11361-0000
Property Address 1 1500 BAYSHORE ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 718-423-8151
Tax Map No. section 53.00 block 4 lot 32.001
Cross Street KERWIN BLVD.
Issue Date: 8/08/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF "t'HE TOWN CLERK c31 F
Ttown of Southold &N) COG Application No.
Judith T. Terry, Town Clerk .�
Town Hall, 53095 Main Road -< $10.00 - Residential
P. O. Box 1179 v' '' - " z' $25.00 - Non-Residential
Southold, New York 11971 ® •. �i'�,',
Telephone
. 1 ,•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
[�
SEPTICyTANK or CESSPOOL
l� a 5 3 / 3 a, /
Operation Permit No.
Fee $ / _ c7z)
•
DATE v// / 7
OWNER NAME: r*'S
OWNER MAILING ADDRESS: - 7 - J 5' 0-07_
B 4-7 s , - // .3 l
OWNER PROPERTY ADDRESS : j `�D� /� y<S c�oa e. ,,
C- K /0 A)N. /79Y7
d
OWNER TELEPHONE NUMBER: 9/ - Y'� 3 -
TAX MAP NO. : Section Block Lot
CROSS STREET: -3 ie Go' vo
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Wit_ Existing
Residential Non-Residential
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.)
Signature re o A lica
ig pp
RECEIVED BY:
Town Clerk's Office
DATE:
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