HomeMy WebLinkAboutRobins gUrtb
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JUDITH T. TERRY �1 0
Town Hall, 53095 Main Road
• TOWN CLERK ® P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �` O � Fax (516) 765-1823
MARRIAGE OFFICER , ®z410 t��t/ 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. 1998-R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
New Existing X
Name Of Owner ROBINS, ALVIN AND MADELINE
Mailing Address 1 181 SYLVAN AVENUE
Mailing Address 2
City St Zip LEONIA NJ 07605-0000
•
Property Address 1 525 GREENHILL LANE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 201-947-7780
Tax Map No. section 33.00 block 2 lot 46.000
Cross Street HOMESTEAD WAY
Date Of Last Pump Out 0/00/00
Issue Date: 10/23/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
4
OFFICE OF THE TOWN CLERK c3VFF�(,r`;- -
Town of Southold � Q Application No./
fi
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road o '�* -'� 7 $10.00 - Residential
p. O. Box 1179 $25.00 - Non-Residential
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ f().
DATE • /O // /f
OWNER NAME: /l /V, DL-- /1/J rZ.17�Q /r � � 4")er .S
OWNER MAILING ADDRESS: je/ s /C,
,� L"�.'� /V i 76 0
OWNER PROPERTY ADDRESS:
G` v o__-€, f o ;�� �l, l / 9 cz,
OWNER TELEPHONE NUMBER: 6.>Z0 / — 9 I17 - 7 7 F v
TAX MAP NO. : Section Block Lot
CROSS STREET: R o h, .rtea. d (A/a
TYPE OF SYSTEM: Septic. Tank I/ 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 Applicant
RECEIVED BY: Or =
Town lerk's Office
RECEIVED- _ .
DATE:
• 00T' 23 1992
Town Clerk go i b i
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