HomeMy WebLinkAboutPenny w
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Town Hall, 53095 Main Road
��®�--,+� P.O. Box 1179
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,�' Southold, New York 11971
JUDITH
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. 1558-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PENNY, GEORGE L. IV
Mailing Address 1 PENNY, SYLVIA V.
Mailing Address 2 9305 SOUNDVIEW AVENUE
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 9305 SOUNDVIEW AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-9261
Tax Map No. section 59.00 block 6 lot 21 .000
Cross Street KENNEY'S ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 10/23/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
ti • III
OFFICE OF THE TOWN CLERK �c�\\FFD(�'�'' _
Town of Southold &f:0:::V.;...ki::'‘;
� , C� '� Application No. /� 1'
Judith T. Terry, Town Clerk . %)
Town Hall, 53095 Main Road $10.00 - Residential .----
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/P. O. Box 1179 u' ,Ki`.` .' 'S";?? �`n 4 $25.0o - Non-Residential
Southold, New York 11971 Q ® . �",�`�
Telephone j
44 1` •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
. OPERATION PERMIT
•
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ / • 0
DATE / U a Ci O
OWNER NAME: 6 V , C_,1 62( t ' �� v�'- S vL_i/ / !,.'i. Yr / �1 1i (
Q1 ,
OWNER MAILING ADDRESS: 1 3, c) r. c� LA- LI V (/ i el If C
SO 1kl- tote ,i\- I ( CM
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: - I-1. ` 7 t ( - 7 ) v r
TAX MAP NO. : Section -J � Block () Lot
CROSS STREET: S 0 1.„.1/4.-A-4.. V/ ( CN.J 6.- le-hel. t--t- 1 ,j
--"4444
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing NI
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: fz.
' 1 ..5 1 -1--'( Vt't
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet .
of distance, approximately, to builditig and closest road.)
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Sigri.ture . App icant)
RECEIVED BY:
-Town Clerk's Office •
DATE:
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