HomeMy WebLinkAboutSayre JUDITH T. TERRY ` Town Hall, 53095 Main Road
TOWN CLERK ��,
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER ® it Fax (516) 765-1823
SO 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. 3053-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SAYRE, BARBARA B.
Mailing Address 1 P. O. BOX 821
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 2445 LAUREL WAY
Property Address 2 (PRIVATE ROAD #18)
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8759
Tax Map No. section 121 .00 block 4 lot 7.001
Cross Street SOUND AVENUE
Date Of Last Pump Out 3/21/86
Issue Date: 6/28/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
q.•
OFFICE OF THE TOWN CLERK I0 COW O6 3
Town of Southold &.1% r CQ � Application No.
Judith T. Terry, Town Clerkr:; $10.00 - Residential
Town Hall, 53095 Main Road • c=::174--r
p. O. Box 1179 cry . : $25.00 - Non-Residential
Southold, New York 11971 0 +
Telephone --"°10.( '°
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE / /Y93
OWNER NAME: - ie L' 9,4 Li/if E-
OWNER MAILING ADDRESS: / t)X Y02�
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OWNER PROPERTY ADDRESS: - J ` / " �
1a.i' e 7I 1//9L-C1
OWNER TELEPHONE NUMBER: (s/6) 9Cf— 4°7L57
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1 TAX MAP NO. : Section /2./.-I/-7. / Block - Lot
CROSS STREET: ..„ vL'L 4i _ . 69-4,G e £
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: J/2./ /09‘
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 Applican� �
RECEIVED BY: • - -
Town Clerk's Office
DATE:
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