HomeMy WebLinkAboutSheppard JUDITH T. TERRY �! ,. '` ,, Town Hall, 53095 Main Road
TOWN CLERK C� : c - =.4 m
tKZD) ^t ` s'; r P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .M1', � s>>,, .'4' 11J Southold, New York 11971
MARRIAGE OFFICER VC"
� ���� Fax (516) 765-1823
® _ � • 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. 1742-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SHEPPARD, DANIEL AND ALICE
Mailing Address 1 2695 OLE JULE LANE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 2695 OLE JULE LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9779
Tax Map No. section 122.00 block 5 lot 14.000
Cross Street KRAUS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/04/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
III
OFFICE OF THE TOWN CLERK ,cjv�FU(A'I�.
Town of Southold A r CQG Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
c rG 1 $10.00 - Residential
p. 0. Box 1179 cr3 �j �' �`
$25.00 - Non-Residential
Southold, New York 11971 Obi
Telephone .( 1► •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT ri@ C E I< V P
APPLICATION AUG 29 BM
for
.)Q�thokl Town Clerk
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /7.4/2,
Fee $ /9-
DATE
q' 2
OWNER NAME: 1>911j1644i-'C c P PA-RAD
OWNER MAILING ADDRESS: zi6pqc oL- L E LAS
ivii-tflJco, ady, n OS-
OWNER PROPERTY ADDRESS: 5*iM e / - V
OWNER TELEPHONE NUMBER: (-2, 167 -1 - 977
TAX MAP NO. : Section /c c,Z Block Lot / (7.
CROSS STREET: etcec 2) ,e-vr c/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential A/ Non-Residential
DATE OF PREVIOUS PUMP-OUT:
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrpw and feet
of distance, approximately, to building and 'closest road.)
i _III ti ��
Signature o Applicant
RECEIVED BY: fityl„.„„,/ / ,
/ Town Clerk's Office
DATE: �7)--i 7
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