HomeMy WebLinkAboutOysterponds /or OfFOLt
•
,� y0 Pi
JUDITH T.TERRY �� yd Town Hall, 53095 Main Road
TOWN CLERK $ P.O.Box 1179
‘‘16)
477$
� �� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `®� ���S Fax(516) 765-1823
MARRIAGE OFFICER �f® V. Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER -°� 'roe
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 158-N Residential Non-Residential X
Fee $ 25.00 New Existing X
Name Of Owner OYSTERPONDS U.F.S.D.
Mailing Address 1 P. O. BOX 98
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 23405 MAIN ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2410
Tax Map No. section 18.00 block 2 lot 23.001
Cross Street TABOR ROAD
Issue Date: 6/18/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i r
OFFICE OF THE TOWN CLERK o��FFQ(�' AJ' - 1 s -'
Town of Southold �� CQG=, Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential
P. 0. Box 1179;' $25.00 - Non-Residential //-
Southold,
/Southold, New York 11971 0 *�`
Telephone �j y1� �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ cQ5
DATE / /79‘
OWNER ,
NAME: 57 PC/VAS' �• IC S'. .1) //5 O, i&vi�
y
OWNER MAILING ADDRESS: Po x 91 43.4466' f>aii? / 0a..d
Ori/E,/r IV y. 1/?s7
OWNER PROPERTY ADDRESS: 23 4l O5 „ faiP3 dad.
Oiev(N� W. y /1q3-7
OWNER TELEPHONE NUMBER: 5/6 -•
TAX MAP NO. : Section IF Block Lot 0?3•
• CROSS STREET:- //150/e - -X9(5,e2;c1
TYPE OF SYSTEM: ,Septic. Tank . , ;. New Existing
Cesspool New Existing
Residential Non-Residential
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 of App 'cant- e J('`'`.
RECEIVED BY:
Town .Clerk's Office - -
• DATE: - - - -
3/- -i/ a//,