HomeMy WebLinkAboutLatson (2) FfOLK
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JUDITH T. TERRY ; z Town Hall, 53095 Main Road
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TOWN CLERK p r�1 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER yQ o. ,t Fax (516) 765-1823
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(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2027-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner LATSON, EDWIN M.
Mailing Address 1 BOX 655
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 1495 ISLAND VIEW LANE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-2034
Tax Map No. section 57.00 block 2 lot 12.000
Cross Street BAY SHORE ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 12/23/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFYCE OF THE TOWN CLERK c3IFOUr R002/7
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Town of Southold �� CQ ' Application_ No. Ri o 1
Judith T. Terry, Town Clerk Nr
Town Hall, 53095 Main Road ' -� $10.00 — Residential
p. O. Box 1179 cry �' $25.00 - Non-Residential
Southold, New York 11971 000�,•,`
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL r
Operation Permit No.
Fee $
DATE ).-1-C t /3, 1 q qg
OWNER NAME: Ij2W/ /1 PI • L A 74-d W
OWNER MAILING ADDRESS: �1�X 6 sir G-.)zez 141 f� c'7 1/-
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OWNER PROPERTY ADDRESS: Al-W. J.:15 LAW" i LA AI -
OWNER TELEPHONE NUMBER: 57 L/'71 )2 (
• TAX MAP NO. : Section LT 7 Block Lot I v2
CROSS STREET: /TAY 5,/l ,?f Aoki
TYPE OF SYSTEM: - Septic Tank = ✓. New Existing
Cesspool ✓ New ® Existing
• Residential L/ Non-Residential
7
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.)
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Signature of Applicant
RECEIVED_ BY:
Town Clerk's Office
DATE:
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