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HomeMy WebLinkAboutJohnstone feerVf vir 41, 1/4 ,r !, Town Hall, 53095 Main Road ����;;1 � 1, P.O. Box 1179 �01 ,� Southold, New York 11971 JUDITH T.TERRY �'�1 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. 1480-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner JOHNSTONE, PETER Mailing Address 1 P. O. BOX 91 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 925 OAK DRIVE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-5309 Tax Map No. section 80.00 block 1 lot 36.000 Cross Street WEST SHORE DRIVE Date Of Last Pump Out 0/00/00 Issue Date: 6/08/90 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK ���F�(��'- Town of Southold Q C0 Application No. He() Judith T. Terry, Town Clerk Town Hall, 53095 Main Road �, :'� $10.00 — Residential P. O. Box 1179 cr3k�t.� r �' ; $25.00 - Non-Residential Southold, New York 11971 �'I® �O •'`� Telephone Q( (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for - OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. JO -/-3� Fee $ 15 ,The, DATE c 'OWNER. NAME: IrrEe J otiA.S j7AJI • OWNER MAILING ADDRESS: /?O. c)X 9/ . Sv�.!19 /l/, / //97/ OWNER PROPERTY ADDRESS: 7,,775—Ot9e_ ,Q,e - OWNER TELEPHONE NUMBER: 7‘,c;-.5'--3 y' ' S'uFfo6,1'4Al' nptUo, TAX MAP NO. : Section /ow•o8O-o13t Block Lot (2,2-0?h CROSS STREET: J { TYPE OF SYSTEM: Septic Tank New Existing Cesspool X , New Existing )K Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: lif (ili o?1 /7,9 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.) 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