HomeMy WebLinkAboutPearsall ,, ....___
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JUDITH T.TERRY �� �� Town Hall, 53095 Main Road
TOWN CLERK 4y P.O. Box 1179
v.. ivy � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS `‘‘-.44 o� Fax(516) 765-1823
MARRIAGE OFFICER - 4 ® i
RECORDS MANAGEMENT OFFICER ®1 �►a�� Telephone(516) 765-1800
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FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3491-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner PEARSALL, DOUGLAS AND BENITA
Mailing Address 1 1725 OAK DRIVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 520 WEST SHORE DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-6224
Tax Map No. section 80.00 block 1 lot 49.001
Cross Street OAK DRIVE
Issue Date: 8/15/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OFTHE TOWN CLERK .c3vFFair
Town of Southold �� CQ Application No; '3 I
Judith T. Terry, Town Clerk ✓
Town Hall, 53095 Main Road �.A ; z4. -� $10.00 - Residential
a � yY.
P. O. Box 1179 u' 'a �' $25.00 - Non-Residential
Southold, New York 11971
Telephone : .(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 9A9/96
OWNER NAME: aagia,S' OeN � S/j1L-
OWNER MAILING ADDRESS: /7 5 fc C
sie
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OWNER PROPERTY ADDRESS: , 1 J4;dge 040 .,
ota4® , H9V/
OWNER TELEPHONE NUMBER:PO XJ- -22
TAX MAP NO. : Section jJ ® Block f Lot We?, /
CROSS STREET: O,4X .Di _
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool � New Existing
Residential V Non-Residential
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.)
RECEIVEDSignature of Applicant
JUL 2 0 1996
RECEIVED B Y: town Clerk Southold
Town Clerk's Office
DATE: 4 i- �� _ . /`
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