HomeMy WebLinkAboutJames CoNsr, 'OE Rm .&r 957
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t` �`` " ''� '�' Town Hall, 53095 Main Road
J Vii`" P.O. Box 1179
i!' Southold, New York 11971
7UDITH T.TERRY ®� =��� � FAX(516)765-1823
TELEPHONE(516)7654801
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. 1014-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner JAMES, THEODORE JR.
Mailing Address 1 RR 3, 1415 INDIAN NECK LANE
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 1415 INDIAN NECK LANE
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-734-5610
Tax Map No. section 86.00 block 5 lot 2.000
Cross Street SPRING LANE
Date Of Last Pump Out 0/00/00
Issue Date: 2/09/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK .•SF�I ,/
Town Clerk
Judith T. Terry, r� �
Town of Southold �•5. xC APP` Application No. /0 /7
` 0
Residential L.-pi'''.Town Hall, 53095 Main Road
o
P. O. Box 1179 v' V� �` *. `
.,�, 4 � Non-Residential
Southold, New York 11971 O ®i --%)\•;°1
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Telephone �j '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. m/4
Fee $ /6 -a
d
DATE D/(F1
OWNER NAME: Th- . dA'112-,
OWNER MAILING ADDRESS: ,€ - , l ' i !j
/IVW L9 < L-
���� Ark
OWNER PROPERTY ADDRESS: S
OWNER TELEPHONE NUMBER: (5'i(o) 73/ — 6"
TAX MAP NO. : Section Block Lot o2
CROSS STREET: "to -ems
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential i/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: 4'L44
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.)
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Signat of Ap licant
RECEIVED BY: ce...ci_a_r_.—
own Clerk's
lerk's Office
DATE: FEB