HomeMy WebLinkAboutLemerise (2) ,i.
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�' Town Hall, 53095 Main Road
•--13'' C'i P.O. Box 1179
__�®d � `�i,�' Southold, New York, 11971
JUDITH T.TERRY ..,,,,i�/'°� 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. 1536-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner LEMERISE, SUSAN J.
Mailing Address 1 108 RIDGE CRESCENT
Mailing Address 2
City St Zip MANHASSET NY 11030-0000
Property Address 1 1475 SIGSBEE ROAD
Property Address 2
City St Zip MATTTIUCK NY 11952-0000
Owner Telephone No. 516-627-3196
Tax Map No. section 144.00 block 2 lot 9.000
Cross Street PECONIC BAY BLVD. & ROUTE 25
Date Of Last Pump Out 0/00/00
Issue Date: 9/28/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
ts-
OFFICE OF THE TOWN CLERKS�FFD(,�
Town of Southold �% C'OG- Application No. A.S"-C34
Judith T. Terry, Town Clerk - r; y
Town Hall, 53095 Main Road -� 1 $10.00 - Residential
P. O. Box 1179 cr3 $25.00 - Non-Residential
Southold, New York 11971
Telephone Y►�� '��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for --
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0. 00
DATE SEer•=2" /
'OWNER NAME: U S /51-0`) �/ I �2i E6r- •
OWNER MAILING ADDRESS: / 0 �' €/D f-E-- 6i2esc�v7�
AMTS 67 N.y / 0 3 d -
OWNER PROPERTY ADDRESS: /z/7 j a A-b - --
OWNER TELEPHONE NUMBER: sG - 6..2_7- 3/ 9 6 S""/G ,-9k-f 3 3
TAX MAP NO. : Section / if Block Lot
CROSS STREET: ,,ET E&W P .(1.4/1 C Efty 61-t D goUT-6— oZS—
TYPE OF SYSTEM: Septic Tank - New -. Existing
Cesspool yES New Existing
Residential Y -5 Non-Residential
DATE OF PREVIOUS PUMP-OUT.: V iU KALICUA/
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:) V
Sign to a of Applicant
RECEIVED- BY.: -
i ± Clerk's Office
DATE: SEP 2819
Town Clad SI ,101.4 " , ,
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