HomeMy WebLinkAboutJellett •OOOOOIl ,,•.�'
, Town Hall, 53095 Main Road
O .' '` I P.O. Box 1179
--�Q�LL ��®i•/ Southold, New York 11971
JUDITH T. TERRY -.fire /II°I TELEPHONE
TOWN CLERK (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. 1055-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner JELLETT, PETER
Mailing Address 1 700 GLENN ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 700 GLENN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5481
Tax Map No. section 78.00 block 2 lot 25.000
Cross Street BAYV I EW ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 3/17/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• •i.,
OFFICE OFTHETOWN CLERK '���F'QO.�'= •
Town of Southold A 4. ea"; Application No. /.66-
Judith
)6Judith T. Terry, Town Clerk tum y
Town Hall, 53095 Main Road r%« r 'e , �C 1 Residential
P, o. Box 1179 '`r%.ti ; Non-Residential
%Southold, New York_ 11971 O�v��®: r '���`
Telephone �?O Aft l
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
• DATE 3//67e32?
OWNER NAME: 'Er", ' 41_
OWNER MAILING ADDRESS: 7ej-0 4,4FjJiJ /'D
,may Ibi7I
OWNER PROPERTY ADDRESS: ,54n4
OWNER TELEPHONE NUMBER: 7
TAX MAP NO. : Section g Block Lot
CROSS STREET: 64y vak- vv
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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: d,
Towi5f Clerk'Tffice
DATE: u _
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