HomeMy WebLinkAboutSouthold Park Dist (3) stI ; f-
JUDITH T. TERRY
'� Town Hall, 53095 Main Road
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P.O. Box 1179
TOWN CLERK ® lei
REGISTRAR OF VITAL STATISTICS .�` Southold, New York 11971
MARRIAGE OFFICER ® o ". Fax (516) 765-1823
�® �! 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. 132-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner SOUTHOLD PARK DISTRICT
Mailing Address 1 P. O. BOX 959
Mailing Address 2
City St Zip SOUTHOLD NY 11.971-0000
Property Address 1 EMERSON PARK
Property Address 2 SOUTH HARBOR ROAD
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1659
Tax Map No. section 87.00 block 1 lot 18.000
Cross Street HIAWATHA PATH
Date Of Last Pump Out 0/00/00
Issue Date: 7/20/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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(2Fwt THE TOWN CLERK cuFFD(,r '
s own of Southold , O�� CSG' Application No.
Judith T. Terry, Town Clerk . Z ��s� tc ,
Town Hall, 53095 Main Road § '' "' -'� ) $10.00 - Residential
p. O. Box 1179 cr'sr •`' $25.00 - Non-Residential
Southold, New York 11971 4:;;)
Telephone = ( Y►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. fi R � J
Fee $ '2S
DATE July 14, 1992
OWNER NAME: Snntholr3 Park nistrirt
OWNER MAILING ADDRESS: P.O. Pox 959
Southold, NY 11971
OWNER PROPERTY ADDRESS: Eni rson Park
Srn,th Harbor Rd, Soiithnld, NY
OWNER TELEPHONE NUMBER: 765 1659
TAX MAP NO. : Section 87 Block Lot /-g
CROSS STREET: 1/90A,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing
Residential Non-Residential X
DATE OF PREVIOUS PUMP-OUT: 5/92
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.)
CL/ `
Signature of Applicant
RECEIVED BY: ilt
Town Clerk's Office
DATE: 7
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