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HomeMy WebLinkAboutFenderson /I ,.o® JUDITH T. TERRYTown Hall, 53095 Main Road TOWN CLERK ® T P.O. Box 1179 REGISTRAR OF VITAL STATISTICS 1=122 ,• Southold, New York 11971 MARRIAGE OFFICER Q ®r Fax Fax (516) 765-1823 ',y®1 �� �► •' 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. 3096-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner FENDERSON, PHILIP Mailing Address 1 P. O. BOX 1127 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 2585 MARRATOOKA ROAD Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-8097 Tax Map No. section 123.00 block 2 lot 23.000 Cross Street CENTER STREET Date Of Last Pump Out 0/00/00 Issue Date: 8/17/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) ti • III • OFFICE OF THE TOWN CLERK •0 c.0FO Town of Southold �� ^�CQ Application No.3°'�6 Judith T. Terry, Town Clerk . ` 47, Town Hall, 53095 Main Roadr.t. $10.00 - Residential P. O. Box 1179 _. 'teri �` $25.00 - Non-Residential Southold, New York 11971 ,53,"07` Telephone ( (516) 765-1801 TOWN 'OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for • OPERAT ION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE !©/9'5 OWNER NAME: i/,t� /9 Pi--////%7 ,,e_5-0� iv OWNER MAILING ADDRESS:/ �(� , 6vX `79 7 /I7, %c,e - OWNER PROPERTY ADi ,9J7 ',4 /f OWNER TELEPHONE NUMBER:( 7) 98 - gp 9 �7 TAX MAP NO. : Section 1D:5 Block Lot o -� CROSS STREET: C'e-44'7 $f TYPE OF SYSTEM: Septic Tank New Existing Cesspool 1 New �xisting Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: 777' 95 - 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.) -- " ignat re of Applicant RECEIVED BY: Town Clerk's Office DATE: a -► Y 0 0 neo`ri. P1' owe/4ar 07//s.,