HomeMy WebLinkAboutFenton JUDITH T. TERRY - Town Hall, 53095 Main Road
TOWN CLERK :T a .' P.O. Box 1179
REGISTRAR OF VITAL STATISTICS rt=;T; P Southold, New York 11971
MARRIAGE OFFICER }.> r_ ' ~ ' 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. 1587-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner FENTON, JOSEPH AND ADELAIDE
Mailing Address 1 300 JACKSON STREET
Mailing Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Property Address 1 300 JACKSON STREET
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-734-5099
Tax Map No. section 117.00 block 10 lot 2.000
Cross Street NEW SUFFOLK AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 1/17/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �uFFOLA-
Town of Southold ea .:" Application No. -(7_
Judith T. Terry, Town Clerk . 4.;
Town Hall, 53095 Main Road •� k y. �,;'� :'� $10.00 - Residential
p. O. Box 1179 1 WW1 $25.00 - Non-Residential
Southold, New York 11971 O ®lif
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Telephone f0/ `j►�� '�0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 17 /q�
OWNER NAME: Took -re oo d' >DeLf u v',tJ/ R-u G°'f
OWNER MAILING ADDRESS: 3 S4LKCokt) SSifee-
OWNER PROPERTY ADDRESS: ,S
OWNER TELEPHONE NUMBER: $7 11F-67:141?
TAX MAP NO. : Section /1 .7
Block Lot `.1.-
CROSS STREET: 3 o44/ Nt&r cvoLb<. /W..
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP—OUT: /V �c/E� /S° "fJ D
c
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.)
� ,%E? fa? 8
Sig :ture of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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