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Home My WebLink AboutPecha FOUr - JUDITH T.TERRY ��/�� ^ '_ Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 k PSI Southold,New York 11971 REGISTRAR OF VITAL STATISTICS , MARRIAGE ®� MARRIAGE OFFICER et� Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER : 41 ' ,•,/ Telephone(516) 765-1800 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. 3721-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner PECHA, ELEANOR Mailing Address 1 468 PENNSYLVANIA AVENUE Mailing Address 2 City St Zip WILLISTON PARK NY 11596-0000 Property Address 1 250 BARTLEY ROAD Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-739-8267 Tax Map No. section 144.00 block 3 lot 30.000 Cross Street Issue Date: 11/12/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) QFFIC.E ,OF THE TOWN CLERK 6 cl\VHU( Town of Southold �� , CQG 4 Application No. 3 744 Judith T. Terry, Town Clerk � y Town Hall, 53095 Main Road r< $10.00 - Residential P. O. Box 1179 tr3_ .`r t * i ;' $25.00 - Non-Residential Southold, New York 11971 co. �0 ��`� Telephone 1 y1 (516) 765-1801 TOWN OF SOUTHOLD • SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /+O • D O DATE /B f /9 7 OWNER NAME: Cc� ce uU O moi P@ -/4 w- OWNER MAILING ADDRESS: //C l y 4) Td iJ ti� ✓(0 I //. �( OWNER PROPERTY ADDRESS : c, 5,—O &_ Q T1 e L/ `'L-- OWNER TELEPHONE NUMBER: 5/(, 7� 9 c ‘ 7 TAX MAP NO. : Section J (-f Block 3 Lot CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool - New Existing Residential 1..7 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.) Si nature of A e icant RECEIVED BY: Town Clerk's Office DATE: , . . . . . . . . . . . . . ce . . . . , . , . . . . -4 . . .. , . . _ . . . . , . . . . . . . . . . ., . . . . . . , . , . . . . . . ,- , . , . ... . . . . . . . . , . . . . . . , ... , . . . . _ ..- . . . . , . . . ., . .. ._ . . . . . _ .. . . ,... . , . , . . . . • 11 I • r . . . : • • . . . • • •- ..4 6 i' .. • .• , n . I - r , . . r. r ` I 1 kla—. ,,, -D, . . . . . . , -- , . _ . _ . .. . , . . , , ._ , , • . . , , .