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HomeMy WebLinkAboutFeigelson 40,- � io JUDITH T. TERRY Town Hall, 53095 Main Road P.O. Box 1179 TOWN CLERK t REGISTRAR OF VITAL STATISTICS .�` Southold, New York 11971 MARRIAGE OFFICER ;1� 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. 1893-R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool New Existing X Name Of Owner FEIGELSON, EUGENE AND LINDA - Mailing Address 1 560 RIVERSIDE DRIVE Mailing Address 2 City St Zip NEW YORK NY 10027-0000 Property Address 1 BACK LANE Property Address 2 City St Zip ORIENT NY 11957-0000 Owner Telephone No. 212-749-8062 Tax Map No. section 17.00 block 4 lot 14.000 Cross Street MAIN ROAD Date Of Last Pump Out 0/00/00 Issue Date: 4/28/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) O =ICE OF THE TOWN CLERK c0FOLli- Town of Southold CQG' , Application No. 7(Y--K3 44. J; dith T. Terry, Town Clerk 0, � � $10.00 - Residential Town Hall, 53095 Main Road s z, P. O. Box 1179 cryo ' F $25.00 - Non-Residential Southold, New York 11971 Om ��•` Telephone Nfr (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE (-IZ5 - Z— OWNER NAME: F Com:C 2XS ©-rte OWNER MAILING ADDRESS: r•=- v-e_ nWNER PROPERTY ADDRESS: Sack_ t o OWNER TELEPHONE NUMBER: (jrzT) ') cf-s Co L TAX MAP NO. : Section i ( Block `1 Lot I 14 CROSS STREET: • TYPE OF 'SYSTEM: Septic Tank - -New Existing Cesspool New Existing Residential L- Non-Residential 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 of App cant RECEIVED BY: Town s : ffice DATE: APR 2 g 199 ;gym Clerk Southiorr - r y" tv S 9-t7 l [�CTcJI S-F Skec( V -- V I new ILW P 1 413 L / A 0 z 3 I • aprtvf.ou zo 5 E J FE:V.0, 6—L c=, CP ainck,-