HomeMy WebLinkAboutJones (2) 'df�d��
�r®
JUDITH T7 TERRY odaC Town Hall, 53095 Main Road
TOWN CLERK , P.O. Box 1179
REGISTRAR O1 CLERK
STATISTICS � Southold, New York 11971
MARRIA E OFFICER
Fax (516) 765-1823
W®�/�ei Pi ®111 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. 1880-R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
New Existing X
Name Of Owner JONES, HAROLD & MARTHA
Mailing Address 1 3940 WESTPHALIA ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 3940 WESTPHALIA ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-369-1331
Tax Map No. section 1 .13 block 9 lot 14
Cross Street OAK LEAF LANE
Date Of Last Pump Out 0/00/00
10Ora
s: 47H
Issue Date: 4/13/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/I.
OFFICE OF THE TOWN CLERK c��FF�(1..'=
Town of Southold ONO (QG' Application No.
Judith T. Terry, Town Clerk % z U •.) �'
Town Hail, 53095 Main Road . $10.00 - Residential _
c
P. O. Box 1179 cry g $25.00 - Non-Residential"
Southeld, New York 11971 ®' ' •=0 �$
Telephone 44,1 `1�
(516) 765-1801
TOWN OF SOUTHOLD ,
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
, APPLICATION
for \
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. MO
Fee $ J', 0.0
• DATE „. .,/,---V.,57-,)
OWNER NAME: ,Att `' 6%., - ,L , r��. ;,•
OWNER MAILING ADDRESS: J t,. -,W 4 " /sae ,
firieMo .AJ y, 1 /91.5;1,
31or
OWNER PROPERTY ADDRESS: ,,e, —.
OWNER TELEPHONE NUMBER: �`i � �,, � -t4 d (ereeri.4,1
1
TAX MAP NO. : Section /A3
/Block 49' ,/
Lot /e
CROSS STREET: tV/72 . '., �_O.A,Q .1,4. .1& od ` / /,T"
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool -w Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: d?
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.)
Signatu - of Applicant
r
RECEIVED BY: IAJA.C//f� a
own Clerk's Office
DATE: 1///3/ 7..
,,c,--,,,,o, 14,h4„-a vb ,
642 ,61z, -
aX410ti..)-142; � -
311,
d
' \-- i
-✓
i