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cze ^' Town Hall, 53095 Main Road
0 ®',4 P.O. Box 1179
Ili ��es Southold, New York 11971
JUDITH T.TERRY ®,_ „ �� 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. 1303-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MARK, JAMES
Mailing Address 1 P. O. BOX 244
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 935 BAY VIEW DRIVE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-2954
Tax Map No. section 37.00 block 1 lot 18.000
Cross Street PARSONS BOULEVARD
Date Of Last Pump Out 0/00/00
Issue Date: 11/13/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK /
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Town of Southold � . • Application No. /302
Judith T. Terry, Town Clerk :014 ik
y
Town Hall, 53095 Main Road N ` $10.00 Residential
P. O. Box 1179 v' ; }?^ i $25.00 - Non-Residential
Southold, New York 11971 O b ° J
Telephone �( 414 •
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for - - - - -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE ///98'9
OWNER NAME: •-74 /ES x. '
OWNER MAILING ADDRESS: 73.5- 1* k) / 0' eoX-7
M,gif/o'i/ A/ `' //9-97
OWNER PROPERTY ADDRESS: 5 i-IE
OWNER TELEPHONE NUMBER: -57C ` 4477 sle
TAX MAP NO. : Section 37 Block / , Lot /
CROSS STREET: t4 5o,Vr �LrA
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential 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.)
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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