HomeMy WebLinkAboutKendall tit Town Hall, 53095 Main Road
� ��� P.O. Box 1179
��.��' Southold, New York 11971
JUDITH T.TERRY •0° TELEPHONE
TOWN CLERK (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. 722-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner KENDALL, GEORGE F.
Mailing Address 1 P.O. BOX 404
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 EDGEMERE PARK
Property Address 2 PECONIC BAY BLVD.
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-8647
Tax Map No. section 126. 00 block 6 lot 16.000
Cross Street MCDONALD
Date Of Last Pump Out 0/00/00
Issue Date: 6/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I
OFFICE OF THE TOWN CLERK VFD ''-
Town of Southold ® - 4® ' Application No. 722
Judith T. Terry, Town Clerk O� w
Town Hall, 53095 Main Road '; ° Residential
P. O. Box 1179s ► : Non-Residential
Southold, New York 11971 ® rte -11' �l,�.
Telephone : ! 4
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
_
for -- _ ____
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME ,,e(,)--y y--T,f,,, - . 6,„-u?,e,e_.
OWNER MAILING AD KESS: /7;/. : ?,c, ..., /0,7 /YT'ce
OWNER PROPERTY ADDRESS • irtcx „� 2
7
OWNER TELEPHONE NUMBER: 74 , '�'� �,� y-`'
i
TAX MAP NO. : Section Block Lot
CROSS STREET:
TYPE OF SYSTEM: Seplie iarrl - _ s lew rEXisting 1, 4�� f�4-,/
Cesspool New Existing; ,76 /r'
Residential / Non-Residential .61„,p_c,. z-c!`-Qlv
DATE OF PREVIOUS PUMP-OUT: �czP \eQ ,z 1�
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.)
Signature of Applicant
RECEIVED BY: a „--- j
Town C'erk's Off ce
DATE:
JUN 01 1989
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