HomeMy WebLinkAboutCommunity realty OFFICE OF THE TOWN CLERK _ $ c.grtU 1
Town of Southold
Judith T. Terry, Town Clerk • � z<"
Town Hall, 53095 Main Road o ,ajar,
P. O. Box 1179 �� =`�
Southold, New York 11971 O
Telephone .4V0/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. NR 26 Residential
Non-Residential X
Fee $ 25.00
Septic x Cesspool
NAME OF OWNER: Community Realty Corp.
OWNER MAILING ADDRESS: 42-08 Bell Blvd.
Bayside, New York 11361
OWNER PROPERTY ADDRESS: 25 Beckwithk 11361 •
Southold, New York ; 4 j
OWNER TELEPHONE NUMBER: 718-229-8887
TAX MAP NO. : Section 61 Block 1 Lot 20
CROSS STREET: Main Road (Route 25)
TYPE OF SYStEM: Septic Tank X New Existing x
Cesspool New Existing
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: Unknown
Judith T. Terry
Southold Town Clerk
DATE: November 20, 1986
a(TOWN' SEAL)
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OFFICE OF THE TOWN CLERK COMA'
Town of Southold ' -%' k; _ Cali': Application No.�
Judith T. Terry, Town Clerk �r y
Town Hall, 53095 Main Road a �5' ` .. Residential
P. 0. Box 1179 u' "fit : Non-Residential
Southold, New York 11971 O O ,y- . .,�0�_f,
Telephone :s. -" ( % , i
(516) 765-1801 �._ �0
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TOWN OF SOUTHOLD 4-
et ' •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT I '
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ,,/t/,e26.
Fee $ ' 2Nui6-0
DATE /%0,/G
OWNER NAME: ayf/�/vir/ £,yrs/ aci4
OWNER MAILING ADDRESS: 62-0f Ae A-ad .
Ayii ) /1/- >< #2-4-/
OWNER PROPERTY ADDRESS: ,c,(5cCza',
OWNER TELEPHONE NUMBER: 7/ct- r►'f- ',if?
TAX MAP NO. : Section e26/ Block 0/ Lot (7-1,-12
CROSS STREET: ea7„, o
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing 4 l
41.,
l/ No - esi ntial
Residential �R I e
�� I ' i
DATE OF PREVIOUS PUMP-OUT: h , ,_,,,_,J---,1,1140,„...,�. i
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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.)
3)11,v4 1DID tj—el- - % 7
41.4i/ Ai
:igna re/of Applicant
RECEIVED BY: �,,� c� ___ - r '�,�
Town Cl 'rk's Offi./Ee
DATE:
NOV2O?n
Togo Clerk Southold
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