HomeMy WebLinkAboutKing (4) m
Town Hall, 53095 Main Road
�`� P.O. Box 1179
� '•s Southold, New York 11971
JUDITH T.TERRY 1 4 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. 658-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner KING, JULIA E.
Mailing Address 1 P. O. BOX 65
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 350 KING STREET
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2465
Tax Map No. section 26. 00 block 2 lot 13 . 000
Cross Street WILLOW TERRACE LANE
Date Of Last Pump Out 11/24/86
Issue Date: 3/25/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
d --_a
OFFICE OF THE TOWN CLERK go
Ca�FF�(�'
Town of Southold Deo4' - CQG';. Application No. 5e
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road o '' " Residential
P. O. Box 1179 rte:, z. r ga. Non-Residential
Southold, New York 11971 *0/4---0"e M .�0� ���`
Telephone .( 0 "e
(516) .765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE qq$
OWNER NAME: a 1E
OWNER MAILING ADDRESS: (Po .86-1( 65,36z )Vc-iA-1 St& L/ -
O r V. / /q57
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: ,32,3-0'7 + 5
TAX MAP NO. : Section ,26. Block a Lot p •
CROSS STREET: ,,1i " / apo o - 4'c lam" p
TYPE OF SYSTEM: Septic Tank ✓ New Existing
Cesspool ,i New Existing s/
Residential ' Non-Residential
DATE OF PREVIOUS PUMP-OUT: mac( / q ,
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 ofVApplicant
RECEIVED BY:
��`1I�—
t ierk's ffice
DATE: (LIAR 2 51988
Town Clerk Southold
/4 r /.51)162.e'1...
4 ; Ric- 0 Ac—z.„..4.....
eJX
li
is
,
I
} '
! i
�� r !
/ I \i
/
— sir �' L -/
- �-