HomeMy WebLinkAboutMayer AO
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� -, '-A Ni Town Hall, 53095 Main Road
=�® f �i P.O. Box 1179
�!� Southold, New York 11971
JUDITH T.TERRY " �,. �', FAX(516)765-1823 TELEPHONE(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. 1036-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MAYER, GERTRUDE V.
Mailing Address 1 BOX 823
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 2095 YOUNGS AVENUE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2599
Tax Map No. section 17.00 block 4lot 18.000
Cross Street ROUTE 25
Date Of Last Pump Out 0/00/00
Issue Date: 3/03/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK \\FFO r
Town of Southold % L'` CD Application No. /0 3C
Judith T. Terry, Town Clerk �� yo ay
1 Residential
Town Hall, 53095 Main Road a ;:,: % .
p. O. Box 1179 cry v. ' 'n Z Non-Residential
Southold, New York 11971 u.O '41('-'
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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 L%z0/ ry
OWNER NAME: Mrs.Gertrude V.Mayer '
Box 823 -
OWNER MAILING ADDRESS: orient, L.I., NY 11957
OWNER PROPERTY ADDRESS: p 7s- VQ rl N �S Rd,
0RI ENT) /ply. /194-7
OWNER TELEPHONE NUMBER: .s-/6 -_22_.3 -��-.77 +
TAX MAP NO. : Section / Block Li Lot /y
CROSS STREET: 5--
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool )( New Existing X
Residential x 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.)
i_Je_r- c-e-.•6 i_,r
Signature of ApplicaI
RECEIVED BY: , (/(4-)41-----,-;
Town Clerk's Office
DATE: 3/ /(f7
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