HomeMy WebLinkAboutLaymon r
Z Town Hall, 53095 Main Road
' ' '$ P.O. Box 1179
' _ 1 iitt •t®.1, Southold, New York 11971
JUDITH T. TERRY
'--..i" 0,0° I TELEPHONE
TOWN CLERK (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. 1103-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner LAYMON, LATHA
Mailing Address 1 P. O. BOX 331
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1095 GOOSE CREEK LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5479
Tax Map No. section 78.00 block 8 lot 7.000
Cross Street NORTH BAYVIEW ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 5/10/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•0 • ii•i,
OFFICE OF THE TOWN CLERK C.SFO(A' -
Town of Southold CQ Application No. /,i
Judith T. Terry, •Town Clerk Yy
Town Hall, 53095 Main Road o . ., :� Residential
P. O. Box 1179 cn4 h�i ` Non-Residential
Southold, New York 11971 p."®1/2fte
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Telephone �
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /o. act
DATE /T1 F7
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OWNER NAME:< ,�5J� �—L7
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OWNER MAILING ADDRESS: /4121d6).
OWNER PROPERTY ADDRESS: ® c aL
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OWNER TELEPHONE NUMBER: i765-5/-(751
TAX MAP NO. : Section . 7 fC Block ' Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential L- 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.)
41a`44-e.- 0(2e- ner-x_i
Signatureo Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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