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HomeMy WebLinkAboutLee 4; F. 410"11 .��. 114\c nfir " ete MINN JUDITH T. TERRY ; ,; 'IV 4 Town Hall, 53095 Main Road TOWN CLERK �l btu€„ - � ��� P.O. Box 1179 ® — - tr til REGISTRAR OF VITAL STATISTICS ., -,a=_ Fax; Southold, N6e 7York 23 971 MARRIAGE OFFICER '-c® �® s� Telephone (516) 765-1801 frie,OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1835-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner LEE, MANFRED Mailing Address 1 P. O. BOX 1282 Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 26850 ROUTE 25 Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-7026 Tax Map No. section 109.00 block 5 lot 3.000 Cross Street HIGHLAND AVNEUE Date Of Last Pump Out 0/00/89 Issue Date: 1/22/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) / „„ OFFICE OF THE TOWN CLERK .5FNA/ Town of Southold � Win, CQG' , Application No./135t Judith T. Terry, Town Clerk �'.` Town Hall, 53095 Main Road +./ $10.00 - Residential P. O. Box 1179 535 L . ' �� $25.00 - Non-Residential Southold, New York 11971 O ®- � �� Telephone ej s� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for • OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. /[3c Fee $ • DATE � / 7- 9� OWNER NAME: ryi nr„,., e_ e- OWNER MAILING ADDRESS: � (S5 ® 4f 23 la©� ,/ r C 716ape /kyr D: OWNEPROPERTY ADDRESS: S �Uy4 OWNER TELEPHONE NUMBER: 76 — 73 Li 7 p 6 TAX MAP NO. : Section /OY Block 3— Lot CROSS STREET: ' `'I //94 ita 0 e ' 4 (ye_ ' TYPE OF ,SYSTEM:--' Septic Tank ` - - New Existing Cesspool New Existing Residential •V Non-Residential DATE OF PREVIOUS PUMP-OUT: , / f� 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 ' DATE:' • ' l.Zt)r'.i�y M • ti AV ; I%r 7�, - G ` n) 1 I -fI a R{ `4 (3 IImo; l ` f 7 r ppr2C*__1 t ..--i 1 s , Ur- ._ 3 o, r, { V� •- i .3),„, :,_ p 1 _ _ 1a` u,l- - - - - - ` lSOr ` ` lot { • . - $1 rIt ? r f \ i Allpir / a'— . if 7; rI .1