HomeMy WebLinkAboutLankshear •
''til 4fUll.GreB-c_=
Y8
Town Hall, 53095 Main Road
P.O. Box 1179
e,On �L,;i! Southold, New York 11971
JUDITH T.TERRY -i.. ,prix" 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. 1479-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner LANKSHEAR, RONALD & DOROTHY
Mailing Address 1 BOX 854
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 545 WOODCLIFF DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5744
Tax Map No. section 107.00 block 7 lot 23.000
Cross Street WESTVIEW ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/06/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK
Town of Southold � ._ C� = Application No. ,,q /
Judith T. Terry, Town Clerk s's= ' ' y
—4 ; $10.00 - Residential
Town Hall, 53095 Main Road �rLf
G
P. O. Box 1179 v'
t�_, ,t $25.00 - Non-Residents I
Southold, New York 11971 • 4 '®
Telephone 101 ' * /
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ( Q
DATE 5 - sem 9O
OWNER NAME: R e-n.cici f s g_64- - 9 -e-a-^ 14-Pn-Le-r--
OWNER MAILING ADDRESS: jo)t WS.LI
Pf r 6-i uc K
OWNER. PROPERTY-_ADDRESS: �E3___
OWNER TELEPHONE NUMBER: 3 Ito - S'1 Lf '(
TAX MAP NO. : Section / 0 '7 Block 7 Lot a3
CROSS- STREET:
TYPE OF SYSTEM:_ Septic Tank New Existing
Cesspool ✓ New Existing
Residential 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 of Applicant
RECEIVED BY:
= Town Clerk's' Office - r -
DATE:
' s �:. 4--0t4 a i m
mss �a�
‘D-1,)
5
_ 1
PcU1
•
9 _� t
77/
IRo