Loading...
HomeMy WebLinkAboutFisher vt'6 r.v.% Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 JUDITH T.TERRY i "! TELEPHONE TOWN CLERK �� (516) 765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 932-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner FISHER, DONALD G. Mailing Address 1 FISHER, SUSAN KRUPSKI Mailing Address 2 P. O. BOX 39 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 2975 YOUNGS AVENUE. Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-2757 Tax Map No. section 63.00 block 1 lot 26.000 Cross Street COUNTY ROAD 48 Date Of Last Pump Out 0/00/00 Issue Date: 11/28/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) As ow. OFFICE OF THE TOWN CLERK CO Fair -- Town Town of Southold Application No. / ? Judith T. Terry, Town Clerk • r ► ✓ I Residential Town Hall, 53095 Main Road W7 P. O. Box 1179 cr' a. �r �`' Non-Residential Southold, New York 11971 O ® "':`' Telephone S®j 0-.s. (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /0', 00 DATE /1/06/i , iq OWNER NAME: -ppijA-Li) G, r'IS &Silk1 kialosK I I-102.. OWNER MAILING ADDRESS: 10 , r--€.Q 9 OWNER PROPERTY ADDRESS: 2975 Jou xi coLA I4oLb ivy 1 tc1-1I OWNER TELEPHONE NUMBER: G�1(-74,C-2Tc? TAX MAP NO. : Section 6 3 o Block I Lot 2(47 CROSS STREET: Ccu Wry RQ4 Lie TYPE OF SYSTEM: Septic Tank "V New Existing Cesspool S New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: /0 °C /1 '•-46 4c—GfaRA ,I 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 cl sest road.) 0,4 Signa re of Applicant • RECEIVED BY: rt7„ , own Clerk's Office DATE: 1, ti - • LocA--r o Al,rp 29'15 Yo k) 6.s - 'c S'ot i Ncot, , 1 I co ) ho i Sze f, &do" x )colon Scot.€ o I " YOLAN/6.5 AVCIVIAE I I 4d POIA5C To ROAD 1 I � MORIM � I I � f I I II I p i , HOUSE ,; I II �a►�r I I SEPTIC �� �{�N I Mirrr I 2�1 I i L'EssP©bL*2 5�1 -T i f I 1 i , • I 1 I 1 I GABA E I I L'rSSPo®L�l ow