HomeMy WebLinkAboutPerlman , Town Hall, 53095 Main Road
P.O. Box 1179
®y � r�•!•, Southold, New York 11971
JUDITH T.TERRY `._J®� i �� TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OI.VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 928-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PERLMAN, STEPHEN & HELENA
Mailing Address 1 910 NEW SUFFOLK AVENUE
Mailing Address 2
City St Zip MATTTIUCK NY 11952-0000
Property Address 1 910 NEW SUFFOLK AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4535
Tax Map No. section 114.00 block 12 lot 8.000
Cross Street MAIN ROAD / OLE JULE LANE
Date Of Last Pump Out 0/00/00
Issue Date: 11/23/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK _ .C3 �Fik/r `
Town of Southold �� C'Q __ Application No9��
Judith T. Terry, Town Clerk P:;•:. w-
Town Hall, 53095 Main Road ;# Residential
P. O. Box 1179 cn -' f=' i •
� . Non-Residential
Southold, New York 11971 04lr*�0*.1
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Telephone ,(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT _
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation
Permit No.
Fee $ /0i 02'
DATE ////0
OWNER NAME: q ,I,„,�' 3 '1 E -p4/A)
OWNER MAILING ADDRES : 9/ o �U ) �1,1-� i/< (—ii -_-
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OWNER PROPERTY ADDRESS: —S /9- i� /
OWNER TELEPHONE NUMBER: -' &J yi 3 $
TAX MAP NO. : Section 1 1L-/ Block / _).....-- Lot c
CROSS STREET: ' /1-1JO / OLD Jul_ CJA
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G g
TYPE OF SYSTEM: Septic Tank
l / New Existing
Cesspool l/ New Existing Z.-/..--
Residential l..,/----- Non-Residential
DATE OF PREVIOUS PUMP-OUT: ///re
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.)
.//_/ee---A- 73-eid."7..rx.../z-&--)
Signature of Applicant
RECEIVED BY: .``-
Town Clerk's Office
DATE:
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