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HomeMy WebLinkAboutPodeyn 0, cr 40 , - f.� ` % Town Hall, 53095 Main Road i� P.O. Box 1179 =.__ ®� ��Sir;��� Southold, New York 11971 JUDITH T.TERRY ,i".�, FAX(516)765-1823 "����� TELEPHONE(516)765-1801 TOWN CLERK 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. 956-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X • New Existing X Name Of Owner PODEYN, JEAN A. Mailing Address 1 3600 PINE NECK ROAD Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 3600 PINE NECK ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-2027 Tax Map No. section 70.00 block 12 lot 4.000 Cross Street OAKWOOD DRIVE Date Of Last Pump Out 0/00/00 Issue Date: 12/13/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) •., - OFFICE OF THE TOWN CLERK Town of Southold &N) CQ Application No. 9s) Judith T. Terry, Town Clerk A r an. �►` Town Hall, 53095 Main Road t_ 1 Residential ✓ C!7 P. O. Box 1179 `, r .` moi ;' Non-Residential Southold, New York 11971 OO 4; �o .�`� Telephone : .( Y► (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for - OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $�Q✓^ - DATE /c9-/-2 / ic`l • OWNER NAME: lam✓' I 116:)( 1/e141 OWNER MAILING ADDRESS:,5‘©o I-/ h - Al c- 0`d, AIS. / / KKf7/ OWNER PROPERTY ADDRESS: (5-'',44791 ic-1.-68'PO OWNER TELEPHONE NUMBER: 5i6 76 „.2_' �7 TAX MAP NO. : Section 0 Block �- Lot ly CROSS STREET: ti TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential Non-Residential / DATE OF PR e - ' MP-OUT: / v/rif3 pc7( /f// j6 g LOCATION MAP: Must be attached hereto before permit may/ bel issued. (Locate building and system; give north arrow and feet of distance, approximately, to building and closest road.) Signature of Applicant RECEIVED BY: a ,-x jcA� , e � RECEIVED V Town lerk's'Office - DATE: DEC 1. 3 19S lora Cleft SC i t'� d I! prii allinallme aI i ■ ilimill mm.mAr.....604.. .0, 11 • .... , ......... ..... imam ill. I „/i/ Am....p.m....... p.m. m m A Aramml......MMERNIM I EMEMME MI EM MMEIMEMNEMEMM . 1110111....ind a• mprom ,_ mmilimimmumm il rrrAit��J mom 1 m mmom ■ C N � 1111 0 EmEMMEMMMEMEME MMEMEMMEMM MEM! MEMMMEM EMMUMEEMMEMEMMM