Loading...
HomeMy WebLinkAboutMay is ,1/I'®���a c®' Miri Town Hall, 53095 Main Road .® �� 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. 1274-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner MAY, JOHN AND ELINOR Mailing Address 1 2080 TOWN HARBOR ROAD Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 2080 TOWN HARBOR ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-1739 Tax Map No. section 65.00 block 1 lot 16.000 Cross Street TERRY LANE Date Of Last Pump Out 0/00/00 Issue Date: 10/17/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) • OFFICE OF THE TOWN CLERK P cvF � FD(,��;• Town of Southold o Application No. Judith T. Terry, Town Clerk t a r• } $10.00 - Residential Town Hall, 53095 Main Road f . p. O. Box- 1179 cn _ $25.00 - Non-Residential Southold, New York 11971 � _ Telephone : 1 (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE OCT / / 9(, • • OWNER NAMEyqf ll/,5 -Joh 'I /f• _/lay J1-h / OWNER MAILING ADDRESS: ?©'Q JO 0-14 ,4 ,,-h it 59,5. v rho /d, /V y l ir-t 71 OWNER PROPERTY ADDRESS: It OWNER TELEPHONE NUMBER: (lj/6J 765.- / 73," TAX MAP NO. : Section 6 5 Block b/ Lot &O CROSS STREET: lel ' / La, TYPE OF SYSTEM: Septic Tank V New i/ Existing Cesspool 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.) Signature of Ap icant ( NrS JoG /-/ / �r� RECEIVED BY: \l Town Clerk's Office DATE: Y�V i __ -- - - - -; '- --- - - - - - - ;i �I , , f— i — 7 - 'A 1 : __ ___ ( ,NiI ! t - , . - 3 - ' , rt •• 1 � E �f• ��ttl� e . ` \----Tr',.,4. ‘. , . - - , %, .‘...______/ \ Ot tI I i ;±± : ti :i , i i 1 . t I ! i 1 it F f-- 1 ;; 2 3 1 s + ; -' z i- 1 ��►Y� ► Y-` - -, yam. - -:- - -, - - - I -j i \ ' r , , ® I