HomeMy WebLinkAboutPeddle JUDITH T. TERRY ��1 L Town Hall, 53095 Main Road
TOWN CLERK ale
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS tiSv r� Southold, New York 11971
MARRIAGE OFFICER ` Fax (516) 765 1823
® N4r 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. 1697-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PEDDLE, RICHARD
Mailing Address 1 3290 PINE NECK ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 3290 PINE NECK ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-4337
Tax Map No. section 70.00 block 12 lot 3.000
Cross Street OAKLAWN AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 6/04/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c3\\FFOLA'
Town of Southold �� C�j' Application No. tc, 'q7
Judith T. Terry, Town Clerk -µ' N:` �='� $1!1,00 - Residential
Town Hall, 53095 Main Road 8 =�"
P. O. Box 1179 cry %" t : $25.00 - Non-Residential
Southold, New York 11971 O s � *�`
'Telephone O.( ���.
(316) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation P: r iit Vo.
- 'Fee $
DATE �/ oZF 97
OWNER NAME: (([ (___V\Pt-q__.
OWNER MAILING ADDRESS: 2 9 o ,e ii\) eco I; ri
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 76� 3 3 7
TAX MAP NO. : Section G Block / _ Lot
CROSS STREET: 0 }fy UCS
TYPEOF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential _✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: ei /V iVo WN
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 o Applicant
•
RECEIVED- BY:
Town Clerk's ffice
7 DATE: 4/a0 27
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