HomeMy WebLinkAboutPerge JUDITH T. TERRY t' Town Hall, 53095 Main Road
TOWN CLERK t tai P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
�® Telephone (516) 765-1801 40/ T32 I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1997-R Residential X Non-Residential
Fee $ 10.00 , Septic Cesspool X
New Existing X
Name Of Owner PERGE, STEVE AND JULIANA
Mailing Address 1 2350 ELIJAH LANE
Mailing Address 2
City St Zip MATTITUCK NY 11952-2404
Property Address 1 2350 ELIJAH LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5915
Tax Map No. section 108.00 block 3 lot 5.016
Cross Street DIRCHWOOD LANE
Date Of Last Pump Out 0/00/00
Issue Date: 10/22/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK COFO(,,- ' 2�,
Town of Southold CQ Application No. /5:7' ."'7
Judith T. Terry, Town Clerk . ��ffi' 41.5:: �` ,
Town Hall, 53095 Main Road . � -'� 7 $10.00 - Residential
P. O. Box 1179 cn �� $25.00 - Non-Residential
Southold, New York 11971 O ® 4 _' ••�`�
Telephone �.� %��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /0 cfE
DATE g /1). 0 9,2.,
OWNER NAME: (.5)-ti/t" 2 s/tiLit9,47/9 PE/OC--c
OWNER MAILING ADDRESS: ai 35-0 1 / Yf h' 4 "9/Ks--
-'1 c �v. -tom //I. / /%� 2. -- ,7 i/ 4/
OWNER PROPERTY ADDRESS: ,, 3 5 ) IL 'ii i) I- t9A/g-
OWNER TELEPHONE NUMBER: 9 qct 5qf /5 (6-m )
TAX MAP NO. : Section/0 5 Block 7.37 Lot /414-5;"%
CROSS STREET: v ,
TYPE OF SYSTEM: Septic Tank New Existing Z-
Cesspool New Existing Z/-
Residential �� Non-Residential
DATE OF PREVIOUS PUMP-OUT: — . /1/0,67-
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 of Applicant
RECEIVED B !p; "
°�� •awn erk's Office
-
DATE: OCT2? 19g?
Town Clerk Midi -
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"` - ,sewage disposal and 4CFt1 Or •stinnly AT M:441TT/TUCK , ' DAT: ,
,tties for this. locati oil hive been TOWN' OF SOIJTH04b., • �..
ected by this department and found SUFFOLK COLIN T Y', NEW YORK h
e 3atisfactdry7i? ,�y— _„�
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