HomeMy WebLinkAboutRhodes CORRECTED PERMIT
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ` ® vqy P.O. Box 1179
REGISTRAR OF VITAL STATISTICSSou
thold, New York 11971
�!' Fax (516) 765-1823
MARRIAGE OFFICER
��— �®��� 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. 1853-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool, X
New Existing X
Name Of Owner RHODES, JOSEPH E.
Mailing Address 1 517 STERLING PLACE
Mailing Address 2
•
City St Zip GREENPORT NY 11944-0000
Property Address 1 517 STERLING PLACE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0392
Tax Map No. section 34.00 block 3 lot 20.000
Cross Street CHAMPLAIN PLACE
Date Of Last Pump Out 0/00/00
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Issue Date: 2/26/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
Ca
JUDITH T. TERRY Town Hall, 53095 Main Road
��� �
TOWN CLERK ` ® f P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER VOo ,'�, Fax (516) 765-1823
�'® �® �! 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. 1853-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner RHODES, JOSEPH E.
Mailing Address 1 517 STERLING PLACE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 517 STERLING PLACE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0392
Tax Map No. section 34.00 block 3 lot 18.000
Cross Street CHAMPLAIN PLACE
Date Of Last Pump Out 0/00/00
Issue Date: 2/26/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFpFI,CE�OF THE TOWN CLERK cSFOC,r•'•
Town of Southold Application No. )
Town Clerk r x i�
Judith T. Terry, .` �'�' �
�� .G $10.00 - Residential
Town Hall, 53095 Main Road c
P. O. Box 1179 v' $25.00 - Non-Residential
Southold, New York 11971 `P. !Albe�`
Telephone
410--.'41,%-
fro
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION.
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. -
Fee $ •
DATE
OWNER NAME: JS a
OWNER MAILING ADDRESS: 6'/7 7TJ jiN4 Pc.
pot2 tg tic/
OWNER PROPERTY ADDRESS: -e�-
OWNER TELEPHONE NUMBER: 5/4.. e-/7 i - o3Q-39
Z-
TAX MAP NO. : Section /COO Block — Lot -,
CROSS STREET: .9 pI/3/a) /2k.
TYPE OF SYSTEM: , Septic Tank New Existing
Cesspool New . Existing
Residential c/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: utilk,Nor.
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.)
F
• Signature of Applicant
RECEIVED BY: ,
Town Clerk's'Office
•
DATE:
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