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HomeMy WebLinkAboutFeerick `"'' Town Hall, 53095 Main Road `� D i` P.O. Box 1179 ® vio 'I. Southold, New York 11971 JUDITH T.TERRY 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. 91-N' Residential Non-Residential X Fee $ 25.00 Septic Cesspool X New Existing X Name Of Owner FEERICK, RAYMOND M., JR. Mailing Address 1 2925 ROUTE 48 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 [FORTH FROK MARKET & DELI INC. Property Address 2 P. O. BOX 790, MAIN ROAD City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-5570 Tax Map No. section 142.00 block 2 lot 22.000 Cross Street LEGION AVENUE Date Of Last Pump Out 0/00/00 Issue Date: 6/16/89 Judith T. Terry Southold Town Clerk • (TOWN SEAL) R 4 - OFFICE OF THE TOWN CLERK c3IH ( Town of Southold - CQ ' Application No. � " " - Judith T. Terry, Town Clerk .` 4". .,',y � � : Town Hall, 53095 Main Road ?c: ..G I $10.00 - Residential Y P. O. Box 1179 ' *i�:' $25.00 - Non-Residential Southold, New York 11971 O` " 014 Telephone 0 �� � (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATEl� (�, _q 1 -i )\I OWNER NAME: In f 1c Tr OWNER MAILING ADDRESS: 5 2+ 48 lact,R-clivitc_ 1 OWNER PROPERTY ADDRESS: 1'40 • f q0 tam f� - -1-tfute, 1 0-Y I keIS ‘'a OWNER TELEPHONE NUMBER: an "Ss 70 TAX MAP NO. : Section 144 Block Lot A- CROSS STREET: L€J iun, TYPE -OF SYSTEM: Septic Tank New Existing Cesspool New / Existing Residential Non-Residential If DATE OF PREVIOUS PUMP-OUT: (p / 6/ /S? 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.) 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