HomeMy WebLinkAboutMarriner .f
Town Hall, 53095 Main Road
e � �r P.O. Box 1179
•��' Southold, New York 11971
JUDITH T.TERRY � "��� FAX(516)765-1823
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. 952-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MARRINER, PHILIP R.
Mailing Address 1 BOX 449
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 SAILORS NEEDLE ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4620
Tax Map No. section 144.00 block 5 lot 28.000
Cross Street OLD SALT ROAD
Date Of Last Pump Out 0/00/85
Issue Date: 12/12/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
s
•
OFFICE OF THE TOWN CLERK COMA' -
Town of Southold Application No.
Judith T. Terry, Town Clerk ' �►
Town Hall, 53095 Main Road a -' Residential
P. O. Box 1179 - • Non-Residential
Southold, New York 11971 O • ` - •
pyo
Telephone 6°.�
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT -
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ (U
DATE / /-9 ce
OWNER NAME: Nur, mArtruNER
OWNER MAILING ADDRESS: BOX 449
02 O SAILORS N L,LL RD.
MATT STUCK, N.Y. '11932
OWNER PROPERTY ADDRESS: fd ,,e__,
OWNER TELEPHONE NUMBER: J /6 ` - -()
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TAX MAP NO. : Section /4 Block Lot Zer
CROSS STREET: God( 4m,/¢ i,Slr' rzwc U//Are /,j/U
TYPE OF SYSTEM: Septic Tank New Existing Z.Cesspool New Existing ✓
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: 61 //f6�
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.)
•
• P(44 „&('Si, nature of Applicant
RECEIVED BY:
-- ! Office
DATE: GEC 1 1S8
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