HomeMy WebLinkAboutPorterfield F 11 /I OUr
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK G T P.O. BOX 1 179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER � Q O� •'� Fax (516) 765-1823
$1D •� Fax
(516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2061-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PORTERFIELD, ELIZABETH
Mailing Address 1 462 MORRIS AVENUE
Mailing Address 2
City St Zip ROCKVILLE CENTRE NY 11570-0000
Property Address 1 345 WEST SHORE DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-766-4339
Tax Map No. section 80.00 block 2 lot 3.000
Cross !Street OAK DRIVE
Date Of Last Pump Out 0/00/76
Issue Date: 3/01/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c1FULA-e,
Town of Southold CQG Application No. �d Co�
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Judith T. Terry, Town Clerk . •
Town Hall, 53095 Main Road $10.00 - Residential
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P. O. Box 1179 u' t ' $25.00 - Non-Residential
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Southold, New York 11971
Telephone *44-
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE �C ",73 --1,9
OWNER NAME: ene,-/A 7a Lb
OWNER MAILING ADDRESS: '42 HOgetS /4
g ock vi L Cc g. ivy /45-70
OWNER PROPERTY ADDRESS: 5 .5' . /-1i _ -
/197 /
OWNER TELEPHONE NUMBER: . /6) 7ioC-- '/*5'
TAX MAP NO. : Section 4L75 gc' Block 1-0 Lot
-CROSS STREET: D7/< gl(/�
TYPE-,OF SYSTEM-:- =Septic- Tank=- C .__New Existing
Cesspool t/ New Existing 1/
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /f 1
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.)
Signaturd of Applicant
RECEIVED, BY: -- --_ -- -- ---
Town Clerk's Office
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