HomeMy WebLinkAboutLoring •
® Town Hall, 53095 Main Road
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P.O. Box 1179
- �®' �� �� Southold, New York 11971
JUDITH T.TERRY ' FAX_ �i•'�" FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 1371-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner LORING, MICHAEL AND TERU ANN
Mailing Address 1 146-26 56 ROAD
Mailing Address 2
City St Zip FLUSHING NY 11355-0000
Property Address 1 20692 MAIN ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 718-353-1757
Tax Map No. section 108.00 block 3 lot 8.008
Cross Street EVERGREEN LANE
Date Of Last Pump Out 0/00/00
Issue Date: 1/29/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK I -
Town of Southold S.�FD`� C' - 13 -1/
0�� Rye,. QG Application No.
Judith T. Terry, Town Clerk �� y '-�1=" Residential
rG 1 X
Town Hall, 53095 Main Road o , s 44140-( ` u'=' �.�s
P. O. Box 1179 cry , tri
-.. � Non-Residential
Southold, New York 11971
Telephone 6401 ' c'��, 6.55p ° I Plem 1� '
(516) 765-1801 2/67
TOWN OF SOUTHOLD •
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10.00
DATE
OWNER NAME: LORING, MICHAEL 8TERU ANN
OWNER MAILING ADDRESS: /1/6-07
HAMPT) ifs RAYS,NV 11 a46 '�CtShit) //3SS
OWNER PROPERTY ADDRESS: 1695 PRIVATE ROAD # 3 a069,2. /ta/h /Pd
CUTCHOCUE, NY 11935- / �-�� k /1////"..r.2.,,
OWNER TELEPHONE NUMBER: 718-353-1757 Or 516 728-P267
TAX MAP NO. : Section 108.00 Block 3 Lot 9.001
CROSS STREET: MAIN ROAD d- rtU GrfeJ-% /-a.a-p
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New X Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
.410
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Signature of Applica �
RECEIVED BY:
Town Clerk's Office
DATE:
,� SUFFOLK CO. HEALTH'DEPT�APPROVAL ,
�� H S. NO. - 9=-50 0
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'� ///" ,';.) '� RODERICK VAN TUYL, P.C.PC ---` - "'
(J ,.., LICENSED LAND SURVEYORS
l� `� )) GREENPORT NEW YORK —
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TELEDYNE POST N41675 \
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