HomeMy WebLinkAboutHorton (3) JUDITH T. TERRY �� Q� Town Hall, 53095 Main Road
TOWN CLERK z F. P.O. Box 1179
REGISTRAR OF VITAL STATISTICS MI
ELM Southold, New York 11971
MARRIAGE OFFICER ,�� Fax (516) 765-1823
�`a ��' Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1705-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner HORTON, RICHARD L. JR.
Mailing Address 1 1465 PINE TREE ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1465 PINE TREE ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5659
Tax Map No. section 98.00 block 1 lot 26.000
Cross Street BILLIARD ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/05/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK . OMi
Town of Southold ��� . CQ ' Application No. /7°
Judith T. Terry, Town Clerk "' y
Town Hall, 53095 Main Road
y tum to �Y,t;� 7, $10.00 - Residential
..'
P. O. Box 1179 �_ $25.00 - Non-Residential
a . ' st�%rc'•.
Southold, New York 11971 u0Y*0-344'
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Telephone .( Y► '�
( 6) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 17)
DATE 6/4/f/
OWNER NAME: ; y)nJ ,4. ghefG,A, T9?.
OWNER MAILING ADDRESS: /11165- �ive -*e , t
Citc-k I // 913-
OWNER
1-OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 9 ' --
TAX
TAX MAP NO. : Section 9TH / sJ Block Lot
CROSS STREET: ,8: '1J
TYPE OF SYSTEM: Septic Tank )( New Existing X(
Cesspool y New Existing X
Residential )( Non-Residential
DATE OF PREVIOUS PUMP-OUT: ✓4/90
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 of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
JUN 051*. 1
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_ 1 _ NAUTHO I D ALTERATION OR ADDITION
YO THIS URVEY IS A VIOLATION Of
3 SLCTIO 7209 OF THE NEW YORK STATE t
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EDU/GOION LAW. i
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ii TII LAi\D SU.VEYOR'S tNiC,.D ECAC OR E
c ee /�� BOSS:U SEAL SHALL N::T BE CONSIDERED
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y; /4/ ONLY TO Thi:PE SO'I FOR'/n OM THE SUR
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i TO THE ASSIGNEES OF THE LENDING INSTI•
d TUTtON.GUAP.ANTCCS ARC NOT TRANSFERABLE
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