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HomeMy WebLinkAboutFisher (2) .o " JUDITH T. TERRY % O Town Hall, 53095 Main Road P.O. Box 1179 TOWN CLERK Ze • REGISTRAR OF VITAL STATISTICS v T Southold, New York 11971 MARRIAGE OFFICER y Fax (516) 765 1823 ‘ � Telephone (516) 765-1801 444 4111 0.° OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1689-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner FISHER, GEORGE H. Mailing Address 1 P. O. BOX 493 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 375 TUCKERS LANE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-3654 Tax Map No. section 59.00 block 11 lot 7.000 Cross Street GRISWOLD STREET Date Of Last Pump Out 0/00/80 Issue Date: 5/09/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) `OFFICE OF THE TOWN CLERK •c311... Town of Southold � C� Application No./6,8-7 Judith T. Terry, Tow Clerk . "�' " y ' . $10.00 - Residential Town Hall, 53095 Mair? Road P. O. Box x,179 t 04 � $25.00 - Non-Residential Southold, New York 11971 Telephone 1% • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLI CAT ION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE ,.-51 J [� OWNER NAME: GE H• ( ( 5E7( • • OWNER MAILING ADDRESS: 1 o `4 -COU L t-± I__) N(-Y - < < 71 — 01493 OWNER PROPERTY ADDRESS : al 5 F! -k1= ks LA h(.L .5 Q L tSWUi-b 51 5OU7t4L Lb OWNER TELEPHONE NUMBER: 51 - 7(o S - 3 (0 5 L-i TAX MAP NO. : Section 5 9 Block I I Lot 7 CROSS STREET: (is E S 4 C 15 Lcl TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential f/ Non-Residential DATE OF PREVIOUS PUMP-OUT: / ©� ��Y� F/F� 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.) zdt--49," Signature of Applicant RECEIVED BY: tio (). / L o4n Clerk's Office DATE: /7'7/ f w_o - 3y, 2 l i 1 V2tV + 1 _ , I -11 375' 1 c� �'�{` it Lti pooLS RAG�, ,� GR IadUsE 35 >`— l. I F - ---7-7-777LIW—,7 4..1 Cr) t �sFPr� 77a-µK- -• o b1 VE N ci C°N4 Li ff f ` h 1 V -- © ci ' ; Y GR '-5 ULD STREET SEPT IG Sy9-T'Eli -- - - - - G EdRGL-- 14 C--Is 1-4E r‹. Sf£/c, 1 - 50 &KI S'AJ O l 1J ST 4 375 -1-u cc<E-Zs I- y SO UT i-�01 b __ -MK MP - =.D = (000 - 59 - 1 1 -7 AM ER_I CSC Kt f_2cI0N