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HomeMy WebLinkAboutLanghans c,Of Wire JUDITH T. TERRY ; O ` : Town Hall, 53095 Main Road TOWN CLERK p T P.O. Box 1179 REGISTRAR OF VITAL STATISTICS ifs �� Southold, New York 11971 MARRIAGE OFFICER V, �' ��, Fax (516) 765-1823 yol $V,• •� 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. 2097-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner LANGHANS, ELIZABETH Mailing Address 1 P. O. BOX 62 Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 630 FLEETWOOD ROAD Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-6556 Tax Map No. section 137.00 block 5 lot 300 Cross Street PEQUASH AVENUE Date Of Last Pump Out 0/00/00 Issue Date: 4/19/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) 1/~ Odp III OFFICE OF THE TOWN CLERK 1FOLe Town of SoutholdC��_` Application Noo�� Judith T. Terry, Town Clerk • Town Hall, 53095 Main Road . $10.00 - Residential 1l';'Y p. O. Box 1179 cryo : - 1 �. $25.00 - Non-Residential Southold, New York 11971 O ®,f" 0 ��` Telephone _O Y►� '� • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE //©1/45 OWNER NAME: /Z /� �2 I.1, �/, ,/,411/4-/ s OWNER MAILING ADDRESS: P a ,e0 yc e 2 et, oz,, e, N 7' /19 cr Lf"- OWNER OWNER PROPER`l Y ADDRESS: ft/e ', J �I ece/(�t e ,° /V ji // c1 s--- OWNER TELEPHONE NUMBER: S/4) 7,FV--‘5$'6 TAX MAP NO. : Section / Block 7 73(Ff ?Lot CROSS STREET: Pp?? aS-4 l'YPE OF' SYSTEM: Septic Tank New Existing Cesspool New v Existing Residential Non-Residential - DATE OF PREVIOUS PUMP-OUT: .3 / 7,2 < , 3 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.) qva,i, h,Signre of A plicant • RECEIVED:BY: Town Clerk's Office - DATE: , Y , of ood5 LA)f'T \ ,041 dm \fir ro soo Id it. et HovSC- 611. { . /0-9