HomeMy WebLinkAboutPrice �$O y`
JUDITH T. TERRY , Town Hall, 53095 Main Road
TOWN CLERK j P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
MARRIAGE OFFICER yo ®� �t, Fax (516) 765-1823
�1D �� Telephone (516) 765-1801
•
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2069-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PRICE, WILLIAM H.
Mailing Address 1 1345 LONGCREEK DRIVE-
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1345 LONGCREEK DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-734-2684
Tax Map No. section 55.00 block 3 lot 30.000
Cross Street LAUREL AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 3/05/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERKl�1FUU(
�1 /�
Town of Southold �%�• `.-G, Application No. OL (J
Judith T. Terry, Town Clerk • 4
Town Hall, 53095 Main Road ..; $10.00 - Residential
P. O. Box 1179 v' ; �.'�_ ' •` $25.00 - Non-Residential
Southold, New York 11971
Telephone e.�^ .0c,"
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ • -
DATE
OWNER NAME: (rUAil 91 B i2 I C, --
OWNER MAILING ADDRESS: j�i'-f `r Lb IV Ll;��,� E
uT(i MY
OWNER PROPERTY ADDRESS: ftf(y--
OWNER TELEPHONE NUMBER: 7t C - i.
TAX MAP NO. : Section Block Lot
CROSS STREET:
TYPE OF SYSTEM: = Septic`Tank- - New Existing
Cesspool New Existing
Residential 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.)
4 ,
` JAi
Signature of''' .plicant
RECEIVED BY: •
-
Town Clerk's Office
DATE:
11; — — -- - • - - ; ,
�` l,D��T1®t� OF COQ .
) /Q . .y- ..'\
f .t
Ili . ,irtie6 '`\ P 1.) 1'
�fr"" -4. '
�i 3i� �1� '' �+ ' �._� '
�t j, u
t , ;i t H .
, .
i H n •.,, - - - -- - r - ....
i .- '�- ��~_1 ,e, '' - -- ..- _ _ , _- ,
je�ls `
:� i
111
I
1,1
•
I