HomeMy WebLinkAboutAcademy ],1 Town Hall, 53095 Main Road
P.O. Box 1179
=__ � °� �� Southold, New York 11971
JUDITH T.TERRY y� �� 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. 83-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner ACADEMY PRINTING
Mailing Address 1 848 HORTONS LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 848 HORTONS LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3346
Tax Map No. section 61 .00 block 1 lot 2.001
Cross Street TRAVELER STREET
Date Of Last Pump Out 6/00/86
Issue Date: 3/10/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
11 '
OFFICE OF THE TOWN--C.1_- ,RK ' FUlL-
Town of Southold � C'� '- Application No�/_4 (S.
Judith T. Terry, Town Clerk • ' �•) Residential
Town Hall, 53095 Main Road o ,
P. O. Box 1179 cn `ezt 'i f
Non-Residential
Southold, New York 11971 p leg - O�'••�
Telephone of •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No./u,f 3
Fee $ a(
DATE
• OWNER NAME: P[ f
C.A:be /ylil� Z &TT) W
OWNER MAILING ADDRESS: 'gLL �S �c Nk
�(4, )A, / ] 11 q) (
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 3/4 7,S - 53 .6
TAX MAP NO. : Section 2 / Block / Lot c>7/
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool > New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 1 q Q
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.) •
Sig ature Ap Iicant
RECEIVED BY: OQ,�, ce ej
Town Clerk's Office
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DATE:
MAR 101tl 9
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For All Your Printing Needs Try
Academj Printing Services
Horton's Lane INCORPORATED 119 Griffing Ave.
Southold, N. Y. Riverhead, N. Y.
_7,65-3346 727-8883