HomeMy WebLinkAboutJohnson (6) }
s'4114. LA(�'li`
,�•0 to
JUDITH T. TERRY Town Hall, 53095 Main Road
ac
TOWN CLERK 1- t P.O. Box 1179
REGISTRAR OF VITAL STATISTICS t� Southold, New York 11971
� Fax (516) 765-1823
MARRIAGE OFFICER ‘.10. � •
jia
®��� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3095-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner JOHNSON, ROBERT
Mailing Address 1 FEENEY, MARGARET
Mailing Address 2 165 WENDY DRIVE
City St Zip LAUREL NY 11948-0000
Property Address 1 165 WENDY DRIVE
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-3817
Tax Map No. section 128.00 block 5 lot 6.000
Cross Street PECONIC BAY BLVD.
Date Of Last Pump Out 0/00/00
Issue Date: 8/17/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK o3IFO
Town of Southold � --. CQ Application No.
Judith T. Terry, Town Clerk . - K, k y •
Town Hall, 53095 Main Road -� ' . $10.00 - Residential
P. O. Box 1179 cr3 ` ; $25.00 Non-Residential
Southold, New York 11971 4 ® • $
#.14Telephone v.9y/ ‘.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE ANGVir 9 1493
OWNER NAME: pot, '' vtv- mmmicp '"
OWNER MAILING ADDRESS: (b e ()time_
Littuvaa ®fir HA to
OWNER PROPERTY ADDRESS: ikokoe.
OWNER TELEPHONE NUMBER: 2A8 - 3591
TAX MAP NO. : Section t 25 Block Lot
CROSS STREET: ®M{ azv-p.
TYPE. OF,SYSTEM: Septic Tarik " 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.)
F
1.. ...
At
i tAh- , _ ,
Signat;' r o !Applicant
RECEIVED,.BY:
Town Clerk's Office
DATE: - -"
r.
, ft
4,74'
„.....,;" . '
' AS
.,4,-:-• .
.. ,.-
CS)
. - )
I ke-144elE
, '• 4\f`''') -W)44. .
V\
\
• •:) i? i1
..,. . -
,.
.. .
.,._
.._.
, .
6 ,
. ,
on. I
. •,
,......_.... ,,