HomeMy WebLinkAboutSalmon Town Hall, 53095 Main Road
=� �� P.O. Box 1179
1 1a®e��� Southold, New York 11971
JUDITH T.TERRY „<� 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. 671-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner SALMON, ALBERT & HELEN E.
Mailing Address 1 P.O. BOX 661
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 YOUNGS AVENUE
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3664
Tax Map No. section 55. 00 block 2 lot 2. 000
Cross Street OLD NORTH ROAD
Date Of Last Pump Out 10/00/79
Issue Date: 4/22/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
Z
OFFICE OF THE TOWN CLERK CO FLU
Town of Southold �o . �Q ' Application No. C 7/
Judith T. Terry, Town Clerk Mat "
Town Hall, 53095 Main Road .- Residential
P. O. Box 1179 Cr' T► .` Non-Residential
Southold, New York 11971 ® $ '®‘c".,•f
Telephone /I
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4 7 /
Fee $ / h, D D
DATE 4/2i1/ oW.; /yam'
OWNER NAME: /Weep/ 1--kiereAre3/91440Ai
OWNER MAILING ADDRESS: PO. /30)( 66/
Soc./14044 L./, AA% //Y7/
OWNER PROPERTY ADDRESS: 7a2-uIv ? S Hue
SSou1 & (d, 4.4,N./. /177/
OWNER TELEPHONE NUMBER: 5/4 - ‘,(
TAX MAP NO. : Section 55 Block � Lot
CROSS STREET: /�' 7/0v714 et,9CI
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /, 77
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:
wn C er"s Office
DATE: / of
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