HomeMy WebLinkAboutLoomis ,
Town Hall, 53095 Main Road
�' :y"' ���' P.O. Box 1179
�;1, Southold, New York 11971
JUDITH T.TERRY EZATELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR Oh VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 897-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner LOOMIS, EARL A. JR.
Mailing Address 1 1002 KATHERINE STREET, #6
Mailing Address 2
City St Zip AUGUSTA GA 30904-0000
Property Address 1 COVE CIRCLE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 404-736-8773
Tax Map No. section 49.00 block 1 lot 18.000
Cross Street SIXTH STREET
Date Of Last Pump Out 0/00/83
Issue Date: 11/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ��cO MirC' ��q,71,
Town of Southold � Application No. 1s
Judith T. Terry, Town Clerk , _
Town Hall, 53095 Main Road _ :'� i Residential
P. O. Box 1179 R3 ,601.
' •'
�-� �> , �i • Non-Residential
Southold, New York 11971 O ®,
Telephone �j *69"/
(516) 765-1801
MEN EO. TOWN OF SOUTHOLD
OCT 1 7 1983 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Tour Clerk Southold
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. �
Fee
$ )3 /''
DATE e,2 % F
OWNER NAME: A_ �'� �yr)'s
OWNER MAILING ADDRESS: )0612- —
742.1 C-4— 3 0 4U
OWNER PROPERTY ADDRESS: CO < . 0-esi- v -4
OWNER TELEPHONE NUMBER: 1�/e-2,1'_ "J 3 4. --1 7 -73
TAX MAP NO. : Section 4? Block / Lot /a
CROSS STREET: cfc
GZ St. d- CL,J,<
TYPE OF SYSTEM: Septic Tank c `' New Existing
Cesspool ✓ New Existing
Residential '" ` Non-Residential
A
DATE OF PREVIOUS PUMP-OUT: W• tIkt1
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.)
T/
Signature of Applicant
•
RECEIVED BY: 4.L7 //.1,
•n Cl •rk's Office
DATE: 0 cQZ /�
1.,,- W
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