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Home My WebLink AboutLevin (2) '► Town Hall, 53095 Main Road tfs P.O. Box 1179 11,„ Southold, New York 11971 JUDITH T.TERRY _-_®1 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. 819-R Residential X Non-Residential Fee $ 10. 00 Septic Cesspool X New Existing X Name Of Owner LEVIN, JACK J. Mailing Address 1 ROUTE 48 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 TERRACE COTTAGE COLONY Property Address 2 ROUTE 48 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-477-1910 Tax Map No. section 135. 00 block 3 lot 19. 000 Cross Street MILL COLONY/CAROLE ROAD Date Of Last Pump Out 0/00/00 Issue Date: 9/08/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) • OFFICE OF THE TOWN CLERK c��FFO(,rC'= Town of Southold � 4t�• � Application No. Judith T. Terry, Town Clerk �� Ate* Town Hall, 53095 Main Road tix•••'F,s, .G Residential P. O. Box 1179 cr' •S; �z Non-Residential Southold, New York 11971 Telephone ( (516) 765-1801 TOWN OF SOUTHOLD aye" e SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE / f OWNER NAM „/°_,// ' OWNER MAILING ADDRESS: S/ � OWNER PROPERTY ADDRESS: cx-cp YEe -r , 7 //,F7 ( OWNER TELEPHONE NUMBER: (6:76) 4/7 7- TAX MAP NO. : Section Block Lot CROSS STREET: 00.41-,-V,7A.,e,(204c/ L/ � ( t4 £oQ/ TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential !/ Non-Residential DATE OF PREVIOUS PUMP-OUT: ,r12,--c,.� 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.) ., ature of Applicant RECEIVED BY: Town Clerk's Office DATE: . , i e 71 do 1./Fs- . _.., • , . ... ils , , e _ -.. 9 , _ ;.---- - e 7 : - - - g . ., ,_..F1 ' „ . . . , . . : , . • . . ,,,,,...........,, . ,..,... . . .__ . , --N' 4..) . .- . , , . . . . _ . .. . , 1, . .- "•••..._.- p , . , . . . . . . . . . 4..., .- - . . .. ct,‘•,., , • , ..... f ,,.....'1‘.. \ . . . . . , . . . . . . . . , . . . _. . . . _ . . . , . • , . . . , . _ . . . I/ .. . . . , - , . - . . . . , . ., . - , ----- • -- a- - _‘_- . .-. ....... . . . , : . . \\ 1 .. . • . j . /1j . „ . - . r,, • - _ , , p ..., _ __. • • , .......-.....,.„ ....... .,., „,.., p......, ,,.. ..,,s- \ .....-....... ..... ....- . pp.. .. . ...-...- .. 7(-- ... .... .......__ . ....._. ...._ . - .•461,.. :,:„.... • • ______...._\ .._ . _____„......