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HomeMy WebLinkAboutLowry 1104/115.111i1 Town Hall, 53095 Main Road VA. � �•'� P.O. Box 1179 __ � -,o� Southold, New York 11971 -��/ A froFAX(516)765-1823 JUDITH T.TERRY 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. 1448-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner LOWRY, THOMAS Mailing Address 1 BOX 224 Mailing Address 2 City St Zip NEW SUFFOLK NY 11956-0224 Property Address 1 355 SECOND STREET Property Address 2 City St Zip NEW SUFFOLK NY 11956-0000 Owner Telephone No. 516-734-6388 Tax Map No. section 117.00 block 9 lot 25.000 Cross Street JACKSON STREET Date Of Last Pump Out 0/00/00 Issue Date: 4/27/90 Judith T. Terry Southold Town Clerk (TOWN SEAL) //I OFFICE OF THE TOWN CLERK �0 �''- Town of Southold Q C'� = Application No. /4'(?,:r7 Judith T. Terry, Town Clerk . i� ` it„. H h '��_ :'� $10.00 - Residential Town Hall, 53095 Main Road P, O. Box 1179 cn �`y ; „1 .c „4 $25.00 - Non-Residential Southold, New York 11971 O ®. '? Telephone ( (516) 765-1801 _ 7 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. /`/(_/c Fee $ )• DATE "(� OWNER NAME: l WVA44 LAW • ge OWNER MAILING ADDRESS: 4 Re!" / ' ify Tr lig S6 - ter -L-2cl OWNER PROPERTY ADDRESS: � 3 Cs" . A bw OWNER TELEPHONE NUMBER: (6 --7. ?8� TAX MAP NO. : Section /0 © O Block /17 Lot 4r- 2- r CROSS STREET: `J aC___ S0"/A �� '►��e4 TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing 2\ Residential Non-Residential 7 DATE OF PREVIOUS PUMP-OUT: OCATION MAP. Must be attached hereto before permit may be issued. (Locate building and system; give north arrow and feet 6'v" of distance, approximately, to building and closest road.) V2-; Signature of Appli ant RECEIVED BY: Town Clerk's Office DATE: APR's 71990