HomeMy WebLinkAboutJett, Joseph (3) SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4328-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner JETT, JOSEPH
Mailing Address 1 4307 39TH PL
Mailing Address 2
City St Zip SUNNYSIDE NY 11104-0000
Property Address 1 55 PLUM ISLAND LANE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 718-937-7087
Tax Map No. section 115.00 block 5 lot 2.430
Cross Street ROUTE 25
Issue Date: 10/31/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
/OP 6
ELIZABETH A.NEVILLE 2* �4\ Town Hall,53095 Main Road
TOWN CLERK g ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` 0, Southold, New York 11971
MARRIAGE OFFICER L 41
0 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �',,' Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER `'_ ,
e'� * I• � southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 /or Non-Residential @ $25 Application No.
le
Permit No.
Owner Name -J 0 silA A4-,k
Owner Mailing Address 11 0 ) 3 "Ph[e
4✓hni ilb Al 11`04
Owner Property Address S.; Ov^. 1.5/4h1 LGA e
6600 `Pki- ( 1U1 1t.°1 S 1
Owner Telephone No. 1 A DO 1-14V1
Tax Map No: Section /_S— Block S Lot a?y 3?
Cross Street
Please check each that applies: New Construction i
Alteration to Existing System
Residential ✓ Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
.k\\' -
t0-31-0(1
Signa e of A plicant Date
Received by: /49/3( dfr