HomeMy WebLinkAboutGogates 11� � eI -
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,. Town Hall, 53095 Main Road
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V Nr 11 P.O. Box 1179
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_ 1 Southold, New York 11971
JUDITH T.TERRY iii 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. 741-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner GOGATES, GEORGE
Mailing Address 1 P.O. BOX 205
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 270 LAKEVIEW TERRACE
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 31. 00 block 9 lot 14. 000
Cross Street BAY AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 6/24/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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•
OFFICE OF •THE TOWN CLERK • �FF0 it -
Town of Southold �� CQG; Application No.-2V(
Judith T. Terry, Town Clerk
-
Town Hall, 53095 Main Road :<= < Residential
P. O. Box 1179 cn `rl Non-Residential
Southold, New York 11971 O t'llSr .
Telephone . 01 , y►�� '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No`.) c-f
Fee $ /0
DATE
OWNER NAME: ,42,,,_12_
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OWNER MAILING ADDRESS: 0 , 4, 1
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OWNER PROPERTY ADDRESS: 'I, d v / % �
OWNER TELEPHONE NUMBER: 2,1„ ,z„.e._,
TAX MAP NO. : Section 4.1 Block - Lot
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
, ,
LOCATION MAP: Must be attached hereto bef a permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
Sig+ature'of Applic. t
RECEIVED BY: 1teLc--0
Town clerk's ffice
DATE: - 1/FX
lvFif
III 9A 198
Town Clerk Southold