HomeMy WebLinkAboutGriswold q,P . Town Hall, 53095 Main Road
® ',��. P.O. Box 1179
�j�.;i Southold, New York 11971
JUDITH T.TERRY '��. � 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. 97-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner GRISWOLD TERRY GLOVER POST 803
Mailing Address 1 SOUTHOLD AMERICAN LEGION
Mailing Address 2 P. O. BOX 591
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2276
Tax Map No. section 63.00 block 6 lot 1 .000
Cross Street TUCKERS LANE
Date Of Last Pump Out 0/00/00
Issue Date: 10/25/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF 'THI= TOWN CLERK 'r
Town of Southold S:
�� • � CQ�' Application No.
Judith T. Terry, Town Clerk % ,...... . ' y
Town Hall, 53095 Main Road - `-~E < I $10.00 - Residential
P. O. Box 1179 ~:"ir:. `r h�iz $25.00 - Non-Residential
Southold, New York 11971 O ® '+g0. . ./
Telephone Q( JEfl �0 .0
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for. --
i
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.4j, 9 -7
Fee $
DATE 72 £ cieble/ m'�
OWNER NAME: 6,7: 6490s/ A701 — /I pieriC.tti Le 9r on/ • •
•
OWNER MAILING ADDRESS: <' 4.-gox ..rfl- Sau /-Ao/49
OWNER PROPERTY ADDRESS:_"y /(sczd S® (044 '/i
OWNER TELEPHONE NUMBER: 7t i 2276
TAX MAP NO. : Section 6 3 Block 6 Lot
CROSS STREET: "7uG/r-tti Lowe
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
Ar_vt,i_i,
DATE OF PREVIOUS PUMP-OUT: 0A/ (rwp,vA/ (2 ?
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 read.)
4
lo,j) 0 `, 1
a ' dimmiblio8f---
Signature of Applicant
RECEIVED BY: ,(L ( rla-��i,,,
Town gl'erk's Oftfice
DATE:
OCT2519b
ion Clerk South*
,
2
e .I
r•-
Par/',`•✓, Z ,a 14,
CcrspovI
,s'
0" '� >
...
,S�`„,C 7a v4 rar
l,d/fc 7 Dl"f'P'.J
fif6r-'1r y
�J t.7Sx 7-4 ai 4-;foe `\`
i t
ift�t6e4 CJra;rr.S
s
369 I\/Si ..
v
V
/D
$1'9'T�s e �crlvr� t 0 C: 1"S.f,f'h°I
sic, 64i.Sri:4" wn Al e,vve'
I
Cce ie /c'-, : iatc 01Z
GRISW'OLD-TERRY•GLOVER POST '#803
AMERICAN ! EG!ON
;U THOU, N. V. 11971
i /4",,,/,' .11,t'4;),?,--/
,
/O/7-149