HomeMy WebLinkAboutJessup 0101707
Town Hall, 53095 Main Road
ems® D � �i'` P.O. Box 1179
1
__ ® Southold, New York 11971
JUDITH T.TERRY TELEPHONE(i6)76sisol
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. 1026-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner JESSUP, ELIZABETH C.
Mailing Address 1 P. O. BOX 1249
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 PRIVATE ROAD
Property Address 2 OFF PECONIC BAY BOULEVARD
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-4376
Tax Map No. section 145.00 block 4 lot 17.000
Cross Street MACDONALDS CROSSING (PVT RD)
Date Of Last Pump Out 0/00/00
Issue Date: 2/17/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'COFail'
Town of Southold moo ; �Q ' Application No. /e '
Judith T. Terry, Town Clerk �� � !Z"- y
Town Hall, 53095 Main Road 1 Residential
P. 0. Box 1179 a ' ' moi ; Non-Residential
Southold, New York 11971
Telephone ®.! NOV
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
foi
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /O -
Fee $
DATE
OWNER NAME: E1-- 1XA \-) � S�S v�
OWNER MAILING ADDRESS: Po . e-Q X
A41\ 7 7 , T vac -y. //
OWNER PROPERTY ADDRESS: PVT ij 0 FF .c-PEce,v 1c A'/ 51-vs)
vrZ,EI 4/.\/
OWNER TELEPHONE NUMBER: 7 4-
TAX MAP NO. : Section 1I' Block `T Lot /-7
CROSS STREET: -)a'1.u,U�. ,oC/PV-2(',
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.)
1'J
/11 n i
lam' I i„,
iU Signature ./Applicant
Applicant
RECEIVED BY� - v1c�Cw
Town Clerk's Off(ce
DATE:
f'ES 1 7 1989