HomeMy WebLinkAboutLeddy _
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�$ Town Hall, 53095 Main Road
Q s• P.O. Box 1179
� ,�.0 Southold, New York 11971
JUDITH T.TERRY 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. 1548-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner LEDDY, JAMES S.
Mailing Address 1 P. O. BOX 288
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 1725 VILLAGE LANE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2436
Tax Map No. section 25.00 block 3 lot 8.000
Cross Street FLETCHER STREET
Date Of Last Pump Out 0/00/86
Issue Date: 10/05/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK"- FO �
Town of Southold �O - CQG'_ Application No. /.
Judith T. Terry, Town Clerk ,xfi ���
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box, 1179 cr3
. ,: �� $25.00 - Non-Residential
Southold, New York 11971 O ® �`
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /s 7
Fee $ /a- co
DATE Ii°7-3/r°
•
;OWNER NAME: JA titS S. blot '
OWNER MAILING ADDRESS: �. ®• /3 ( V
oRitarr N/ 1057
OWNER-IPROPERTY ADDRESS: /7l/c. ViLkAU 1.4d, .
®:t a dr iy /I 9.7
OWNER TELEPHONE NUMBER: 31/3� 71.rg3
TAX MAP NO. : Section S Block 3 Lot r
CROSS STREET: `-� ? ��_,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool B/ - 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.)
Ae.
Signature Appli
RECEIVED BY: / / V
Town Clerk's-0tfice
DATE: /019(.)
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