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HomeMy WebLinkAboutGriffith atiteor r,, � � Town Hall, 53095 Main Road • P.O. Box 1179 t_V N`rt 01 Southold, New York 11971 JUDITH T.TERRY `�= , �/�r!� FAX(516)765-1823 TOWN CLERK TELEPHONE(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. 1213-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner GRIFFITH, RICHARD P. Mailing Address 1 BOX 356 Mailing Address 2 City St Zip LAUREL NY 11948-0000 Property Address 1 1475 PECONIC BAY BLVD Property Address 2 City St Zip LARUEL NY 11948-0000 Owner Telephone No. 516-298-4603 Tax Map No. section 145.00 block 1 lot 2.000 Cross Street LARUELWOOD DRIVE Date Of Last Pump Out 0/00/00 Issue Date: 8/11/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) •0 OFFICE OF THE TOWN CLERK _.�FF�j-LA. ' Town of Southold %--3 r,_. ea = Application No./ Judith T. Terry, Town Clerk ` 0=72 n y sn .G%) $10.00 - Residential Town Hall, 53095 Main Road . P. O. Box 1179 u' x r: r .•:� s":,:;3 �. $25.00 - Non-Residential Southold, New York 11971 � _�0 ��` Telephone j (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /Q.• 0�J DATE OWNER NAME: /R/ eft, /e- 1".• OWNER MAILING ADDRESS: &)C 3\57 OWNER PROPERTY ADDRESS: M-7‘.5"--- PE 'CoAJ/C Imy L /\10` /r 9 -N- OWNER TELEPHONE NUMBER: (67-) 2y 9603 TAX MAP NO. : Section Block / Lot, 2. CROSS STREET: 27111RFLL eve,0_0 OF SYSTEM: Septic Tank New Existing Cesspool New 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.) // ./ Signature of Applic.nt' RECEIVED BY: All LL )--) Town Cies Office DATE: SV(G F, a E r U 0 } U. k7 i • i -- -- a0d / . . <1.1j > I : U� `- • , z N 7S ' r_ o'�- I, (9,eWcr1/4 c , 5‘,-- . es , • . ____ 0 _ :, ,. ,c, i ,___--------------' , 6 (14\ . c) _q of \ 2 �+ - 1 � 1 o �O ��j0 =� '.� ,© • W - 7 L? 0 - II). a 0 0 -- -0 I IA� ► r C ,i 4/ 1 r 1 S 65 L? W- I �' � fl - �" / MAP cF- 1.-...=.t••a3 SLQ\-' Ya: FC..w.. R1 C. •--! j'. r".-.; G ,.ACE C-7q: 1rE ( T. r GLACtYC.4,f''UCCJ i%) + - : GIA4]Y.'1tit,:•;=..vd i;'11:: A Div, — 4141c...:•1 i`c.xt: T!-,� 1r.zitAl C . . � cic- d "�'o 4(-1 � �",v.1r1-f�a i .L...1V•,�'.s. B k t._--A C.i 1?T �,r. Cu �za 1V c Y ff S l t',- `;,r ! T „}-t ;.....1:."1, I'Df:.- TOWN OF ;aCLiT-HOLtom. Ht�/ ���Ff "`"c ��tv � ,yjJ! ' a 7,i