HomeMy WebLinkAboutScharadin _
e 0 01 Kt c%
td4a 4 �
Town Hall, 53095 Main Road
t® - ` P.O. Box 1179
�1 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. 1152-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SCHARADIN, MARGARET
Mailing Address 1 BOX 364
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 MAIN STREET
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6671
Tax Map No. section 102.00 block 3 lot 8.000
Cross Street FLEET NECK ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/15/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
A I _
I•I II III I
OFFICE OF THE TOWN CLERK
Town of Southold zQG Application No. /A5-3._/
Judith T. Terry, Town Clerk �' e' kt
Town Hall, 53095 Main Road a of - � $10.00 - Residential
P. O. Box 1179 � �^�{ � ��` $25.00 - Non-Residential
Southold, New York 11971
Telephone Y►�� '��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /1)
DATE i,
OWNER NAME: Mr eET e. 4 ►°�
OWNER MAILING ADDRESS: eli( g64
altjr-C4\nitt°,) illAIJKle-k PAY
OWNER PROPERTY ADDRESS: ; __See_n
adre,h 09,t& ..t 11).e,w r6e_k.
OWNER TELEPHONE NUMBER: 734P- 47(
TAX MAP NO. : Section SW = 4 van/
CROSS STREET: l:.A � � () !►V 1 6Q�
CC�l4 `wate )714
TYPE OF SYSTEM: Septic Ta k New Existing
Cesspool IV New Existing v
Residential V 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.)
Si natur of Applicant
RECEIVED BY:
GacSPAP Clerk's Office
%¢
DATE: JUN
y
:3 FautheM JUN15 ammo %0.1
Tan eirah .shr0�
•
o
_
_ _
- tic
Not
rii
_
_ _ _ _
_ _
_ _ _ _ _
. _
F
f
624 I
_ C:5 )
V
Rt.) _ _1
_ _
_ _ _ _
- - -- -- - ------- ------ --