HomeMy WebLinkAboutJohnson (4) 04,14
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Town Hall, 53095 Main Road
P.O. Box 1179
4
1\ � �_., Southold, New York 11971
Cn
JUDITH T.TERRY 4`1.-
TELEPHONE
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TOWN CLERK (516) 765-1801
REGISTRAR 01-VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3583-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner JOHNSON, IRENE
Mailing Address 1 1678 HANNINGTON AVENUE
Mailing Address 2
City St Zip WANTAGH NY 11793-0000
Property Address 1 1540 SEAWOOD DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-785-3671
Tax Map No. section 79.00 block 8 lot 3.000
Cross Street BAYV I EW ROAD
Issue Date: 2/11/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c3IFU(,U(`;•=
Town of Southold ��t Qli Application No.
Judith T. Terry, Town Clerk Y, r ;
Town Hall 53095 Main Road
, � $10.00 - Residential
P. O. Box 1179 x ,`. 1514;e Z' $25.00 - Non-Residential
Southold, New York 11971 •
Telephone 10 ak4. � 0 0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLI CAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE •
OWNER NAME: 4.- -g 7 (-/ I\Jso4'
OWNER MAILING ADDRESS: /b7 4/9- iv -7 jv 4-v- --
/ 116-H . /1 ??-3
OWNER PROPERTY ADDRESS: /6316 5 O /Y1 a ,1)
o , mac-o4-J)
OWNER TELEPHONE NUMBER : 574-- 7d a -.-�� 7J1
TAX MAP NO. : Section / Block e Lot
CROSS 'STREET:-
TYPE O
TREET:TYPEOF -SYSTEM: = Septic Tank--= '- = - .---New Existing
Cesspool New Existing
Residential Non-Residential
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.)
t .At. ..�
ignati,f of Applicant
RECEIVED_ BY:
oven 'CI rk''s Office ' `
I..I1I:
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