HomeMy WebLinkAboutJohnson rig elf,1
Town Hall, 53095 Main Road
O r or P.O. Box 1179
V®2 � :��� Southold, New York 11971
JUDITH T.TERRY „%// r'!�� FAX(516)765-1823
TOWN 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. 1114-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner JOHNSON, ALICE G. K.
Mailing Address 1 26 SUMMER STREET
Mailing Address 2
City St Zip FOREST HILLS NY 11375-0000
Property Address 1 220 NORTHVIEW DRIVE
Property Address 2 BROWN'S HILLS
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 718-263-5459
Tax Map No. section 13.00 block 1 lot 6.000
Cross Street NORTHVIEW DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 5/22/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK ���F�D(x • ;
Town of Southold C•.;.- Application No.
Judith T. Terry, Town Clerk 441 �'`
-�:,- � � Residential
Town Hall, 53095 Main Road t �?_ .
P. O. Box 1179 cn �r. . ; Non-Residential
Southold, New York 11971 u.O ® ` S;:,.;
Telephone
� I'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
FEB 107989
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL.
Operation Permit No. -
..
Fee $ /6' •
DATE .�/�': 1 a b9
OWNER NAME: 11,!' • ► jI • v 1 ' Et a
OWNER MAILING ADDRESS: 249 5 (oto wie.r "treeol.
fOreS—V11;11C. N.Y- 11 X3lb '
OWNER PROPERTY ADDRESS: a }
tor() 114q tT4 N j ®c I e n.r "'N• 1 ''S1
OWNER TELEPHONE NUMBER: 1 (� ^ 6s 514,x7
a
TAX MAP NO. : Section( '
oc " 64T"r -- L 61/ 41 9D
1' ": e 3%1;0 11.J1fti i"esict)
CROSS STREET: ,11/ 4, ,--• v.. S.. ,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool t7 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.)
•
AN. Sig .-ture . Applicant
RECEIVED BY: ' '
R Town Jerk's ffice
DATE:
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