HomeMy WebLinkAboutGarside JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK 17=8
T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 'ilk �� Southold, New York 11971
MARRIAGE OFFICER ,•, Fax (516) 765-1823
�,y®1 1D,0� Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL_
Operation Permit No. 2063-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner GARSIDE, DONALD AND ELIZABETH
Mailing Address 1 165 L'HOMMEDIEU LANE -
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 165 L'HOMMEDIEU LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5019
Tax Map No. section 64.00 block 2 lot 23.000
Cross Street HOBART ROAD & FOUNDERS PATH
Date Of Last Pump Out 0/00/00
Issue Date: 3/03/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK C.1\FF1 ( •
-
Town of Southold ..S .. r CQ�: Application No. 0,663
Judith T. Terry, Town Clerk � ,
Town Hall, 53095 Main Road 41k
"= �` • I $10.00 - Residential
u
P. O. Box 1179 trs " ` $25.00 - Non-Residential
Southold, New York 11971 O ,A,. �o ���`
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Telephone = .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 02-62 � y3
•
OWNER NAME: Dor) td Gar-S" t Ie
OWNER MAILING ADDRESS: /1 LiPiornmfds-ect L-ri
500-r hl td ' J y. a 19 7 1
- OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 6-IL 7625- 5-0 / 9
TAX MAP NO. : Section 6, cf Block ( Lot OR- ;
CROSS STREET: 140 bar-4- KC: /rounct.ers' Path
TYPE OF SYSTEM: ' S'eptic' Tank • :-- New Existing
Cesspool 6— New Existing
Residential 'Non-Residential
DATE OF PREVIOUS PUMP-OUT: a/ (9,
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.)
nature f Applicant
RECEIVED BY:: - -
Town -Clerk's Office '
DATE:
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