HomeMy WebLinkAboutJan Associates gip///L%iii,,,
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gg ce.Y,:- ,,3, 4, ; ; Town Hall, 53095 Main Road
oviz tot P.O. Box 1179
9 t0! Southold, New York 11971
JUDITH T.TERRY `®`� �
-�-��iilg�'�' FAX(516)765-1823
TQWN CLERK TELEPHONE(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. 942-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner JAN ASSOCIATES
Mailing Address 1 CAEMMER/MURPHY/MCLOUGHLIN
Mailing Address 2 11 POST AVENUE
City St Zip EAST WILLISTON NY 11596-0000
Property Address 1 10 LAKE DRIVE
Property Address 2 REYDON SHORES
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-747-8573
Tax Map No. section 80.00 block 4 lot 1 .000
Cross Street REYDON DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 12/06/88 Judith T. Terry
Southold Town Clerk
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(TOWN SEAL)
A �
OFFICE OF THE TOWN CLERK c��FFO(,tr
Town of Southold Q C� Application No.
Judith T. Terry, Town Clerk
. . I Residential
Town Hall, 53095 Main Road r k
L17 .224,2 ?i,
P. O. Box 1179 U �� Non-Residential
Southold, New York 11971
Telephone ul ..ao �•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /6,C0
DATE /2-12-/"
ue,44/ /,e-/�C/vimc2g/f/ /ANN /LP, mUJI
OWNER NAME: /Z'4u//GrLf 4/4/1 41.6iai/4- ff S
OWNER MAILING ADDRESS: /( /.5
_i467_ �AL� !5 7'U� /� Y/S 9 6
OWNER PROPERTY ADDRESS: /6 4414" bA/ V e-
e y11ti nes ("Or 'LL /IV /� 70
(4r )). J �/ -��y= ss-13
OWNER TELEPHONE NUMBER: �S7'i-Ec.b) - q -- Pt'
3 ,
TAX MAP NO. : Section Block Lot /
CROSS STREET: / t/ b ,t)
TYPE OF SYSTEM: Septic Tank New Existing
/
Cesspool // New Existing
Residential Non-Residential
F/R 57" pvo'CN4.5Cb
DATE OF PREVIOUS PUMP-OUT: Pio/2R?/ //V /0/8-3
-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.)
-*9/rGL& Ala , i/e2frk4-4-
. ,, : ' AP-664e4r4/ i /C/G( "40-
Signaturee of Applicant
RECEIVED Y: .`*/ 4;__s I . - ,��__ /
vg'P Town Cler 's Offic-
DATE: DEC 0 6 1988
1 -
_ F
TOWN OF SOUTHOLD Ticket No. ? J�J
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�� BUFFO,�o t''; ',-,}y,
SCAVENGER WA E REPORT _� , } �p � Fee: $.02 per gallon r
�l 'i` - `�
-^ Fee $vV r.. Paid ;.
Name of Hauler. . ✓. . . `'" Date�. P7 .-.paid
'{
Southold Town Clerk '1 ''
Permit Number " , , , •;,.-'' ,;
(`jr
6.
Truck Capacity } /490
Jn{ Gallons Liquid Waste : :sa, 's: ._ „y`�A,; ' ,t,
Date Pumped z . ,f:- r'
Residential • !� Commercial Restaurant , "'
Location: - , S {',r;,,:; .' i a,
Name of Owner. .,, D
',
Street /DjLLJ4 .1)@ Hamlet. 114"
Telephone Number .`'I���.V 3. . Tax Map Number aro_V—I - +.
.Cross Street ,� 'dome) ,P A-e- i
Diagram (locating building and 'cesspool. Give north arrow and feet of distance,
approximately.) t7v®� r , .
,,� o u 4 f�-�. 5
.71 n iv 6 p 0 ii
I hereby certify that the above originated within the Town of Southold at the above
location(s), and to the best of my knowledge, contains no chemicals, hazardous or toxic
waste. All statements made hereby are made punishable as a misdemeanor pursuant to
Section 210-45 of the Penal Law of the a of ew York. / -
Name of Driver Mte dela. !L � / .�
Signature of Driver
Received by Q
0 '
Date . . Y Time .f� � ��'
(1) Treatment Plant
(1) Treatment Plant