HomeMy WebLinkAboutFreeman JUDITH T. TERRY �� ft° ' "*.%-- Town Hall, 53095 Main Road
TOWN CLERK g P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v T Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
® 4-1 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. 1687-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner FREEMAN, EDWARD L. AND MARY L.
Mailing Address 1 P. O. BOX 523
Mailing Address 2
City St Zip AQUEBOGUE NY 11931-0523
Property Address 1 275 CLEARVIEW AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-722-5177
Tax Map No. section 70.00 block 8 lot 39.000
Cross Street WILLOW POND ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 5/07/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c�VFFD(ir
Town of Southold � ,,=- CQG Application No. e6 g
Judith T. Terry, Town Clerk r <` 4*, �.6) $10.00 - Residential
Town Hall, 53095 Main Road „__ -L-
P.
P. O. Box 1179y t3y;
�_, z $25.00 - Non-Residential
'
Southold, New York 11971 O ® `1'7 '�••`
Telephone ®1 * stt
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. / Z. 9-7
Fee $ /` •1
DATE /19-,X/1' 49 /9 /
OWNER NAME: Z®cv/i?,v I. st /y4","/ �• f /cL—'L�o riA
OWNER MAILING ADDRESS: Pb &vac d 3
d-J6jva✓3oGrJL, Aly //93/ os 2-3
OWNER PROPERTY ADDRESS : 7 J" CLQA-r?v/P 6o
uTyv4 , o/y/
OWNER TELEPHONE NUMBER: 7-2a - 6///77
TAX MAP NO. : Section � Block Lot 2
CROSS STREET: euiCLocv et.)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ! New rel- Existing
Residential 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.)
°' 6" C - 740.- -4P
Signature of Applicant
RECEIVED BY•V4e/4 ,
To rn C . k's Office
DATE: ) C/
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SUFFOLK CO. HEALTH DEPT. APPROV.P
H. S. NO. -r;0?-50-q24-
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- MAP O' ?;2O P E 2 , ,
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= L.'...' CONFORM TO THE STANDARDS OF 1
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SUFFOLK COUNTY DEPT. OF HEAL
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---.,,I, CONSTRUCTION ONLY
i• ' DATE:
H. S. REF. NO.. 9°----S0"126 -
APPROVED:
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OWNERS ADDRESS:
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GREENPORT NEW YORK `:•^t. ND'' -.-