HomeMy WebLinkAboutMathews i 0
N, Bila.„..�,
,1 0 (, �t,
(r) W � Town Hall, 53095 Main Road
;`�'r if 'V is P.O. Box 1179
1sgt �,e' Southold, New York 11971
JUDITH T.TERRY -- irr�iii'-I 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. 1520-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MATHEWS, RICHARD F.
Mailing Address 1 200 CENTER STREET
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 200 CENTER STREET
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4676
Tax Map No. section 123.00 block 2 lot 22.000
Cross Street MARRATOOKA ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 8/21/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
7~ I III
OFFICE OF THE TOWN CLERK _ oS FiTur '-
Town of Southold Application No. /5-c2.0Judith T. Terry, Town Clerk : es 14 '' G
Town Hall, 53095 Main Road = ,�;_` �C $10.00 - Residential !�
p. O. Box 1179 ( 'f" 'k-t;.44 -
cry ��._�:.
*-$
�� $25.00 Non-Residential
Southold, New York 11971 4 "® '0-1° �`
Telephone Oj
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No.
Fee
$ � °
DATE '( - 2I ,- q0
OWNER NAME: MP . l r ' eA.
1
OWNER MAILING ADDRESS: zoo lents B1-c et
1\1(1.k-hi hick , Nei) yr lc.. 1lct5a
OWNER PROPERTY ADDRESS: 200 l2en &i--ceek
McW6ib)ek r Nem) ynrk 11gS2.
OWNER TELEPHONE NUMBER: ,51k, — 2 d1 8•- Lk01(0
TAX MAP NOSection / 2.3 Block c Lot AZ.,
CROSS STREET: .fr�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X 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.)
-1,64,444 /la,.��?
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
AUG 21 19.k.l,f-
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