HomeMy WebLinkAboutSaunders (3) }
141 tf�
�®� a
[:yrs .. ,
Town Hall, 53095 Main Road
`� y • 44 P.O. Box 1179
® ��r'���0. Southold, New York 11971
JUDITH T.TERRY � FAX(516)765-1823
TOWN CLERK TELEPHONE(516)7654801
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. 1128-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SAUNDERS, LYNDA AND FRANK
Mailing Address 1 615 DEEP HOLE DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 615 DEEP HOLE DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5283
Tax Map No. section 115.00 block 13 lot 6.000
Cross Street NEW SUFFOLK AVENUE
Date Of Last Pump Out 0/00/77
Issue Date: 5/31/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
iI Y '1 "...i
OFFICE OF THE TOWN CLERK cvFFUUr • ..
Town of Southold 0�% «, } CSG_ Application No.
Judith T. Terry, Town Clerk ‘ 1., jr e?� �►
r y ;,
Town Hall, 53095 Main Road
.1-.5 , .cel Residential
P. O. Box 1179 �lik >.�,-;..�: �i \ Non-Residential
Vim '. '` 4.4:;„•,9' \
Southold, New York 11971 O � �0�•�`
Telephone ( * et
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
fb
eve
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. „_
Fee $ IO '
DATE J � i I
OWNER NAME: d� , ----0,, r.., se,„_c J
vl _
OWNER MAILING ADDRESS: ( c 7 -Qe(p I---to 6 1)Y
1 c, fes-hu k s�—
I �
OWNER PROPERTY ADDRESS: SavyLe crY ( ____
OWNER TELEPHONE NUMBER: cid o� 9. Sa8 3 #
TAX MAP NO. : Section ) I� 3 Block 13 _ Lot (O
CROSS STREET: r)ec.c) S tib C k.c_e�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential t.Z Non-Residential
DATE OF PREVIOUS PUMP-OUT: I 9 1
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.)
46, _raze,,.:_ xe. ..
Signature of Applicant
RECEIVED BY: , COX---e-%---2-
own Clerk's Office
•
DATE: ( 7(t-?
•
•
•
•
•
•
•
•
•
•
•
•
\•
I
�" v
•
•
•
--