HomeMy WebLinkAboutJester 10.
.11 CogFOL/r
f,
r"7,��% Town Hall, 53095 Main Road
VO ' P.O. Box 1179
'I �i 1�®�'�o Southold, New York 11971
JUDITH T. TERRY 01�� .` TELEPHONE
TOWN CLERIC (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. 1058-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner JESTER, ROBERT AND DIANE
Mailing Address 1 314 CHAMPLIN PLACE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 314 CHAMPLIN PLACE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1868
Tax Map No. section 34.00 block 3 lot 24.000
Cross Street MAIN STREET AND STERLING PLACE
Date Of Last Pump Out 0/00/00
, Issue Date: 3/22/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
11 4 ��„„
OFFICE OF THE TOWN CLERK \FFO
Town of Southold Q�j :. �D�; Application No. /0 ,5-41
Judith T. Terry, Town Clerk �� rx y
Town Hall, ~ ' 'r = -� 7 Residential �/
53095 Main Road
n*
P. O. Box 1179Lg. 1 3+ aft::
�� Non-Residential
Southold, New York 11971 O ® / e'�
Telephone Oj }`t • •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE ` 1 (g9,
OWNER NAME: %' CM"\-• ) •,�
OWNER MAILING ADDRESS: ,--;lt4 fiInVLl6q. t_ CC
OWNER PROPERTY ADDRESS: s� �
OWNER TELEPHONE NUMBER: Mpg
a _
TAX MAP NO. : Section 3y Block Lot a�-f
CROSS STREET: CHT v Lltu PL €E,-CWEE`t4 \cc1•nmS T. S1-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing 3K
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: cgJ (.D/ 6%
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 pplicant
RECEIVED BY: Q � ���
Town Clerk's Office
DATE:
MAR 21 1989
J '50
oovsC
e k-vc- \cw L\tNl PLIC c�
ROBERT JESTER
314 CHAMPLIN PLACE
GREENPORT,N.Y. 11944
(516)477-1868