HomeMy WebLinkAboutMarschean C ,' ,xr
u• Town Hall, 53095 Main Road
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TELEPHONE
JUDITH T.TERRY c 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. 908-R ' Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MARSCHEAN, MICHAEL J.
Mailing Address 1 430 TERRY LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 430 TERRY LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2367
Tax Map No. section 65.00 block 1 lot 8.000
Cross Street HOBART ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 11/09/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 'cvFFO(,r - 9`aTown of Southold , � _ , ��G� , Application No.
Judith T. Terry, Town Clerky y
Town Hall, 53095 Main Road Residential
P. O. Box 1179 to -� ;' Non-Residential
Southold, New York 11971
Telephone ( `��
(516) 765-1801
TOWN OF SOUTHOLD
IMA SOUTHOLD WASTEWATER DISPOSAL DISTRICT
SE 0 '
IWr SQ (I APPLICATION
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: l C`/Z? G ✓ i /14,4411-3-C10444, '
OWNER MAILING ADDRESS: 113 6 /
OWNER PROPERTY ADDRESS: 3� �u�7 ,.0r
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OWNER TELEPHONE NUMBER: 5L (( / 765. €22-3 ,(7
41-6+ TAX MAP NO. : Section 65- Block l Lot D
09o44" •
CROSS STREET: y .6/ (20-e
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing V 02 S .7/1-5
Residential
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: , 11/.05V/-1-11
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.)
nature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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