HomeMy WebLinkAboutKing (7) Town Hall, 53095 Main Road
. �r P.O. Box 1179
ak
ro Southold, New York 11971
JUDITH T.TERRY 00- 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. 1061-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner KING, WALTER J.
Mailing Address 1 P. O. BOX 97
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 PINE TREE ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6104
Tax Map No. section 104.00 block 1 lot 9.002
Cross Street BAY AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 3/29/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c�vFFD(,(r°'=
Town of Southold g(A-';
� CQ Application No. )00
Judith T. Terry, Town Clerk �` ►:'
Town Hall, 53095 Main Road i..� =4= ' Residential
P. O. Box 1179 = r*. i �`' Non-Residential
Southold, New York 11971 O,y�" , ,.Y- , ��`�
Telephone ;?1*.� 4 ���
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
. for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /e16 /
Fee $ It(�
DATE 3 Oc-4. S'y
OWNER NAME: 0ci (1 er J . K;r,jj
OWNER MAILING ADDRESS: p. O. cox ct7
cu ir/leto eAz N Y 10 i3,-s-
OWNER PROPERTY ADDRESS: Rrl,e Tree Poi
�u f- - o5u.e ti`f 119 36"
OWNER TELEPHONE NUMBER: 7341 - 6 IDy
TAX MAP NO. : Section 1011 , Block 1 Lot a , Ud D
CROSS STREET: ga. / AVcrluc- e
TYPE OF SYSTEM: Septic Tank X New ;( Existing
Cesspool X New x Existing
Residential X 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.)
Signature ature of A lican1�
9 pp t4
RECEIVED BY: 9
,( `1
Town/ Clerk's Office
(9 '0-7 DATE: (9 ` �7
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TELEDYNE POST N81329