HomeMy WebLinkAboutHeins (2) JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK tD fFt
1 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER
M� O �4' Fax (516) 765-1823
® �44' Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 126-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner HEINS, WILLIAM
Mailing Address 1 THE CANDYMAN
Mailing Address 2 MAIN ROAD
City St Zip ORIENT NY 11957-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2675
Tax Map No. section 18.00 block 5 lot 1 .000
Cross Street OYSTERPONDS LANE
Date Of Last Pump Out 0/00/00
Issue Date: 3/02/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK •SVFFOUre,
Town of Southold Application lication No./t" x`24
COG' ,
Judith T. Terry, Town Clerk
53095 Main Road - $10.00 - Residential IR
Town Hall, c 4. r�
p. 0. Box 1179 Cf3V.74V $25.00 - Non-Residential
Southold, New York 11971 O ® es
Telephone 64 i 0
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- - - - for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No/tit/24
Fee $ g, %L
DATE 4--q
OWNER NAME: 'O\ \\\O -\ S •
OWNER MAILING ADDRESS: R\\N \RA
Iiqsq
- OWNER PROPERTY- ADDRESS: }-Me_ - --- -- - __
OWNER TELEPHONE NUMBER: 3,93- 06373-
TAX
6375TAX MAP NO. : Section Icd Block $ Lot
CROSS STREET: 0\(54e,' PO,DaS `'?c\
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential X
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.)
. _
Signature o Applicant
RECEIVED BY: ba,u-
Town C(erk's Office
DATE: RECEIVED
MAR 0'' 199?
town Clerk Southold
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