HomeMy WebLinkAboutMaston 4,t®4f
® ��
Town Hall, 53095 Main Road
r ��` P.O. Box 1179
el �i�® 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. 1346-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MASTON, CORNELIUS
Mailing Address 1 P. O. BOX 703
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 500 ELIJAHS LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8742
Tax Map No. section 108.00 block 4 lot 12.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 12/19/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c0FO(,r - /Lz/J�,
Town of Southold ��f " CQ Application No. f /il
Judith T. Terry, Town Clerk `,fi fes}
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 cr3 tP4;t ..
$25.00 - Non-Residential
Southold, New York 11971 OLS 0���`,
Telephone ,( `0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE /17/77/7
OWNER NAME: ( n R I / L ,' (,{ S Al A S /ll •
OWNER MAILING ADDRESS: ✓ , U , 1.3 n 70-3
/ e • /1), ,
- OWNER //
-PROPERTY `j ��- - rrl 71 17/ A
1 tri`T/r. n N //92---
OWNER
/9zOWNER TELEPHONE NUMBER: c99' 74
TAX MAP NO. : Section /0 Blockik Lot / 2_
CROSS STREET: /qftf/t) 6�"D
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 1�' New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /e5/2 v ,,ity
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:
C51 SRP
1)3+
®_
,
• o
\Nr\r\r\A\
H aZicip
�C�iv 10� GLef.) LUQ l
QOJLUS OAS-Mk
S 1.1 LAS PU 8ox qta
TITOak( Mv. rrgsZ_