HomeMy WebLinkAboutMarsich JUDITH T. TERRY : rt, Town Hall, 53095 Main Road
TOWN CLERK (s1P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .q Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
�® �! Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1877-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MARSICH, WINIFRED
Mailing Address 1 P. O. BOX 743
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 260 GARDINERS BAY ESTATES
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-2028
Tax Map No. section 37.00 block 1 lot 14.000
Cross Street DOGWOOD LAND
Date Of Last Pump Out 0/00/00
Issue Date: 4/20/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c,VFFO(���'-
Town of Southold % ----. 4r, ' Application No. 1F? 7
Judith T. Terry, Town Clerk
1 I $10.00 - Residential
Town Hall, 53095 Main Road :
P. O. Box 1179 T' z' $25.00 - Non-Residential
Southold, New York 11971 ,Qh:, ``'` "°0.�$
Telephone of j�
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1 9- 7 7
Fee $ WO0
DATE ! - /b - r�
OWNER NAME: 1 in i r .a. 00,..t-s cl
OWNER MAILING ADDRESS: TO 3px 73
&Lei- IM ar i GA , Niltd
11 `1 31
OWNER PROPERTY ADDRESS: 0.6(1 c..krcrt;d,vr-% Zvi �4. +..,t..e., `—
Ec,.a. IV\cri�,i Nit 119 31
OWNER TELEPHONE NUMBER: S- 1(g, - L y awe
TAX MAP NO. : Section 3'7 Block / Lot N{
CROSS STREET: Zor 6-0-4 La,.,„�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing j
Residential J 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.)
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