HomeMy WebLinkAboutGray (2) JUDITH T. TERRY , Town Hall;53095 Main Road
TOWN CLERK �O eZT P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ' Southold, New York l 1971
Fax (516) 765-1823
MARRIAGE OFFICER Q
,901 �1D®��� 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. 140-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner JIM GRAY REALTY INC.
Mailing Address 1 P. O. BOX 166
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 50300 MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5333
Tax Map No. section 70.00 block 2 lot 15.000
Cross Street JOCKEY CREEK DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 3/19/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK •cOWI�- 1
Town of Southold �� CQ • Application No /
Judith T. Terry, Town Clerk . 4`�{ r ;
Town Hall, 53095 Main Road $10.00 - Residential
p. O. Box 1179 .` $25.00 - Non-Residential
Southold, New York 11971 OO40����
. ..
Telephone _
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE lid ' / 99-3
OWNER NAME: Gra�y , �e
V
OWNER MAILING ADDRESS: ,D oar /"G / .5030zo ///�'i.v �� b
_c uta, //q 7/
OWNER PROPERTY ADDRESS: :5-630-6 a,;,) / -1
c�r-1 /c% //97/
OWNER TELEPHONE NUMBER: 5- -76 _533_
TAX MAP,NO. : Section Block Lot
CROSS STREET: ocle.
TYPE OF "SYSTEM: Septic Tank New Existing
• Cesspool New Existing DC.
Residential Non-Residential t(
DATE OF PREVIOUS PUMP-OUT: /A9/93
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.)
Signe of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: