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HomeMy WebLinkAboutLogan + 0001 i7/Fig,,,' JUDITH T. TERRY ; 1® Town Hall, 53095 Main Road TOWN CLERK ® ► , P.O. Box 1179 REGISTRAR OF VITAL STATISTICS tin � Southold, New York 11971 MARRIAGE OFFICER /� Fax (516) 765-1823 --IA!! 4, *boo Telephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3020-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner LOGAN, LAURA E. Mailing Address 1 P. O. BOX 1898 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 1145 OAKWOOD DRIVE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-2955 Tax Map No. section 70.00 block 13 lot 10.000 Cross Street NORTH BAYVIEW ROAD Date Of Last Pump Out 0/00/92 Issue Date: 5/14/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK ,cjvffetir ©� O Town of Southold ��� �.: CQG' Application No. Judith T. Terry, Town Clerk �r Town Hall, 53095 Main Road ~ :4 $10.00 - Residential P. O. Box 1179 o ;, s�; $25.00 - Non-Residential Southold, New York 11971 O •� po Telephone 1 Y► rose (516), 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for RECEIVED OPERATION PERMIT MAY 07 1993 SEPTIC TANK or CESSPOOL Southold Town Clerk Operation Permit No. Fee $ • DATE evt/4-y 7l r V93 OWNER NAME: 4v/2F9- r--� OWNER MAILING ADDRESS: IP- C3 _ (P9P 50v acv /1'L7 /r ?'7/ — / 9P OWNER PROPERTY ADDRESS:- /1 I/5 0 G9--k-E.0 060 ,),.‹) t. $o �vfmay' ifPf OWNER TELEPHONE NUMBER: 76,x- — 2 ? TAX MAP NO. : Section 7d o Block — /3 Lot —/0 CROSS STREET: A.,„/2„ . ggii (677c./ /3-) TYPE. OF SYSTEM:- Septic Tank ' - New Existing Cesspool New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: / W____ LOCATION MAP: Must beattachedhereto before permit may be issued. (Locate building and system; give north arrow and feet of distance, approximately, to building and closest road.) • - Signature of AiClicant RECEIVED- BY: .� • Town Clark's Ofice DATE: 5777 r j - 2A- L LO )& ') ( p7/ 46 cess l J Pao ct -