HomeMy WebLinkAboutPerrine 00.
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r Town Hall, 53095 Main Road
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Southold, New York 11971
JUDITH T.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. 1286-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PERRINE, MARILYN E.
Mailing Address 1 79 HOLDRUM STREET
Mailing Address 2
City St Zip HILLSDALE NJ 07642-0000
Property Address 1 275 BEACHWOOD ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 201-664-3236
Tax Map No. section 116.00 block 4 lot 27.000
Cross Street DEAN DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 10/30/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c��OFO(,��
Town of Southold o u CQ Application No. /fin,
Judith T. Terry, Town Clerk `
Town Hall, 53095 Main Road * ""' ° '`' �,l $10.00 - Residential
p. O. Box 1179 u7
� �� "10'2�.' $25.00 - Non-Residential
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Southold, New York 11971 ® -;E7"
Telephone _Q( , IN
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /Q `'-c-'
DATE / f ,iii7
OWNER NAME: Mari YJ o Perroe •
OWNER MAILING ADDRESS: 1 qfi
5111-
�. ;11 coal N . 07�
OWNER PROPERTY ADDRESS: A7, v. ndb--e.Y4 WV-e44-.-
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OWNER TELEPHONE NUMBER 0/6 £co 3,-36
TAX MAP NO. : Section 71 (2' Block Lot 1011
CROSS STREET: Deor Doc/e-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing r,/
Residential I/ Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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 BY:
rIgI, Ierk's Office
DATE: OCT 3 01989
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