HomeMy WebLinkAboutPenny im
\r -
r:= Town Hall, 53095 Main Road
Ph- ®� �i� P.O. Box 1179
®� Southold, New York 11971
JUDITH T.TERRYFAX(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. 90-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner GEORGE L. PENNY, INC.
Mailing Address 1 P. O. BOX 57
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0400
Tax Map No. section 53.00 block 2 lot 27.001
Cross Street KERWIN BOULEVARD
Date Of Last Pump Out 0/00/00
Issue Date: 6/13/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
_ . ..
•
OFFICE OF THE TOWN CLERK �c�vFFO(,r�'- g1
Town of Southold o C - A lication No.
Judith T. Terry, Town Clerk
f
Town Hall, 53095 Main Road -.. -� L :4 1 $10.00 - Residential
P. O. Box 1179 u' i •
� , �� � `�• $25.00 - Non-Residential �•s , ��0
Southold, New York 11971 O ® "=
-fix,.- : O�'��
Telephone Oj `�t '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE (pI3/ri
'OWNER NAME: C C:•-•°"-(367: L c PLI P .-
OWNER MAILING ADDRESS: iS 0 /` --;
7
cai-,.._t.,p0--L,c-c p1/4_,k,../( 1 ( cl Ley
OWNER PROPERTY ADDRESS: VUL vk, I r', .D
�� � �-' t i.S q^ ,
OWNER TELEPHONE NUMBER:( m ( a
TAX MAP NO. : Section Block Lot 0,7 , f •
CROSS STREET: ket4-_•(. v,_, 9,LO N
I '
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New " Existing
Residential 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.)
.
Sig tur o Applicant „.....
„,
RECEIVED BY: , �r ,
own Clerk's Office
DATE: JUN 12 b.„-,
von oat rte