HomeMy WebLinkAboutRyder 1/71/02/,
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` j�. Town Hall, 53095 Main Road
/ P.O. Box 1179
nr.° Southold, New York 11971
JUDITH T.TERRY == „ � 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. • 998-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner RYDER, ROBERT J.
Mailing Address 1 2400 SIGSBEE ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 2400 SIGSBEE ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4908
Tax Map No. section 144.00 block 1 lot 21 .000
Cross Street PECONIC BAY BLVD
Date Of Last Pump Out 0/00/00
Issue Date: 2/02/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 0q
S��F� Ck l �l
Town of Southold Z `- ' CSG•,, Application No..?7 b
Judith T. Terry, Town Clerk ` , `' it it Q1
Town Hall, 53095 Main Road " :` ! Residential
P. O. Box 1179 cn 7'� V: :;! -, `'
� F• ,�;,.< ._�' �, Non-Residential
Southold, New York 11971 O�f� 0�•�`
Telephone �f l '°
(516) 765-1801 1 � .
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. '2 ',/
Fee $ /6
DATE e4• 1 ' li
OWNER NAME: I13 67E k /0 6--?-z
OWNER MAILING ADDRESS: o2 V00 57 .--F/36-Z ie /)
/12 /52- 77'7 7-U C/ / // ‘/M--
OWNER PROPERTY ADDRESS: J-19-7-21 r
OWNER TELEPHONE NUMBER: �/ 297'1 ' V7 C,
TAX MAP NO. : Section NI Block J Lot ;-1
CROSS STREET: A-CO-7 (() /7/9 7 ,e L 6,60
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool t--------
New Existing L
Residential i_— Non-Residential
DATE OF PREVIOUS PUMP-OUT: 6 /�
LOCATION MAP: Must be attached hereto before permit may be issued.
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(Locate building and system; give north arrow and feet
i of distance, approximately, to building and closest road.)
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Signature of s p. ican P'
RECEIVED BY: ,: 1/(-464--
i'o l, Clerk's Office
• DATE: 2-IL- ri
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