HomeMy WebLinkAboutSouthold School Dist w,
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JUDITH T.TERRY � _ tt Town Hall, 53095 Main Road
TOWN CLERK y - P.O. Box 1179
� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ® 47$
MARRIAGE OFFICER \-4.4*
4* Os/ Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER ®�( .000. Telephone (516) 765-1800
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. 168-N Residential Non-Residential X
Fee $ 25.00 New Existing X
Name Of Owner SOUTHOLD SCHOOL DISTRICT
Mailing Address 1 420 OAKLAWN AVENUE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 420 OAKLAWN AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5400
Tax Map No. section 70.00 block 2 lot 23.001
Cross Street ROUTE 25
Issue Date: 7/02/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I •
OFFICE OF THE TOWN CLERK C31FFe(,( I
Town of Southold , �� �Q Applic tion o.
:2.8
Judith T. Terry, Town Clerk y
Town Hall, 53095 Main Road a -� $10.00 - Residential
P. O. Box 1179 v' ' 4i $25.00 - Non-Residential X
Southold, New York 11971 O *-$
Telephone 4fe= .( * 0),"
(516) 765-1801
TOWN OF •SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 25:00
DATE 6/15/97
•
OWNER NAME: SOUTHOLD UFSD
OWNER MAILING ADDRESS: 420 OAKLAWN AVENUE, SOUTHOLD NY 11971
OWNER PROPERTY ADDRESS: SAME
OWNER TELEPHONE NUMBER: 516-765-5400
SEE ATTACHED
TAX MAP NO. : Section �6 Block C2— Lot
CROSS STREET: �S
TYPE OF SYSTEM: Septic Tank X New Existing X
Cesspool New Existing
Residential Non-Residential X
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 Applicant
dl RECEIVED B Y: RECEIVED
own Clerk's Office
DATE: JUN 3 0 1997
Southold Town Clerk
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