HomeMy WebLinkAboutGamble JUDITH T.TERRY ; Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
• h` �� �' �� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS +® V
MARRIAGE OFFICER : ���" ®� � Fax(516)765-1823
RECORDS MANAGEMENT OFFICER � e tod Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ,••''
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3310-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner GAMBLE, JACK
Mailing Address 1 245 BRAY AVENUE
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 245 BRAY AVENUE
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-4569
Tax Map No. section 126.00 block 2 lot 3.000
Cross Street MAIN ROAD
Issue Date: 2/15/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE 0,,F THE TOWN CLERK 000F0(,t '=
-1" Town of Southold �� ,, ( Application No53/6
Judith T. Terry, Town Clerk ; ',r;, :'{ �, '�'
Town Hall, 53095 Main Road 8 : . : $10.00 - Residential
P. O. Box 1179 cry 4,1;=-` , �,. ;' $25.00 - Non-Residential
Southold, New York 11971 O` ` •
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Telephone 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ l0„
DATE f'e-6 8 - ( ? ?
OWNER NAME: _.1 LC, C-;(11-01V-Di,
OWNER MAILING ADDRESS: 2 L)5 ? c \) .e._
L ,,,,..),„a ) 1 y ,s''
OWNER PROPERTY ADDRESS: . - y5 6N(0 y ave.
Lou y .r..( 1I N / ( 7 q q
OWNERL .
TE EPHONE NUMBER: �l � _ Zq� _ c ) (�
TAX MAP NO. : Section y 7 3 E 1 Block / 2- G Lot 2- -- 3
CROSS STREET:
TYPE OF SYSTEM: ' Septic Tank New Existing
Cesspool Vf New Existing
Residential ✓ Non-Residential
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.)
GGa��2f"t�-
S' re of Applicant
RECEIVED BY:
:te`•:.6, rk's Office
DATE: FEB- 1 5 1995
[own Clerk Southold
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