HomeMy WebLinkAboutLawrence JUDITH T. TERRY ' rZ; Town Hall, 53095 Main Road
TOWN CLERK �, P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
Southold, New York 11971
MARRIAGE OFFICER � C) ��`� Fax (516) 765-1823
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e® ,o! 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. 1839-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner LAWRENCE, ROBERT
Mailing Address 1 975 LITTLE NECK ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 975 LITTLE NECK ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5167
Tax Map No. section 97.00 block 8 lot 3.000
Cross Street EUGENES ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 2/12/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERKOM
Town of Southold � CQG Application No.
Judith T. Terry, Town Clerk 5 •
Town Hall, 53095 Main Road 4 7 $10.00 - Residential
P. O. Box 1179 cr3 ` $25.00 - Non-Residential
Southold, New York 11971 0 � ��`
1 'zi-179 cr3 j
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
° SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ f ®' oo
DATE Z _ 3
•
OWNER NAME: li® 06 u-)6i +� eE
OWNER MAILING ADDRESS: 7 7 L,i rrie ,,Veep: ( a ty
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Cu c-14 /6 N• 7`: 179 j
OWNER PROPERTY ADDRESS: 041, ~ � " —
OWNER TELEPHONE NUMBER:- 7 3 1-76 7
TAX MAP NO'. : Section Block Lot
CROSS STREET: GE 5 IR p,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool i New Existing
Residential 1/# Non-Residential .
DATE OF PREVIOUS PUMP-OUT: /� 2 " 7 - 7 "2--
LOCATION
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximatelya___to_building. and closest road.)
Signa ure of Applicant
RECEIVED BY: - - - - - _ -
Town Clerk's Office
DATE:
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