HomeMy WebLinkAboutAmerican tap and tool s����--•ate,
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Town Hall, 53095 Main Road
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i �® P.O. Box 1179
'��, �� Southold, New York 11971
JUDITH T.TERRY 11��,®`2 `� 4.7
JUDITH
TOWN CLERK , (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. 167-N Residential Non-Residential X
Fee $ 25.00 New Existing X
Name Of Owner AMERICAN TAP AND TOOL
Mailing Address 1 P. O. BOX 1680
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 11170 OLD SOUND AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-1078
Tax Map No. section 142.00 block 1 lot 19.000
Cross Street FACTORY AVENUE
Issue Date: 12/27/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•R OFFICE OF THE TOWN CLERK 8c,UFFUL4- = �,�
Town of Southold ' �� CSG Applicatio N"o.
7
Judith T. Terry, Town Clerk Z
Town Hall, 53095 Main Road a
$10.00 - Residential
P. O. Box 1179 c.r3i' $25.00- Non-Residential 1/
Southold, New York 11971 OO �O�i
Telephone _ 1 4110 , '
(516) 765-1801 •
TOWN OF SOUTHOLD =
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 19 ����'�/
OWNER NAME: Jw c# I Jeofi 4i 7-W2 I))
_-. . OWNER MAILING ADDRESS: -PO CBCY j 6S D
= hM97�1177. COC GJ' // 9 7/
OWNER PROPERTY ADDRESS: Il J '70SC ,t'7 4141
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OWNER TELEPHONE NUMBER: „,2 ?-/b 17k 0.4) ~'��
TAX MAP NO.: Section /44Block / Lot •�
CROSS STREET: FA C G2 `
• TYPE OF SYSTEM: Septic Tank New Existing
•
Cesspool New Existing
Residential Non-Residential X
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.)
RECEIVED
DEC 27 1996 Signature of Applicant
Southold Town ClerkRBY:
Town Clerk's Office
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