HomeMy WebLinkAboutPollett 1.1
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Town Hall, 53095 Main Road
:_�® o '`$ P.O. Box 1179
® �`a��t Southold, New York 11971
JUDITH T.TERRY
"--:',...,,,o04-'I TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERIC
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 804-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner POLLETT, RICHARD
Mailing Address 1 85 BEACH ROAD
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 85 BEACH ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0488
Tax Map No. section 43 . 00 block 3 lot 7 '. 000
Cross Street LANDING LANE
Date Of Last Pump Out 0/00/00
Issue Date: 8/29/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
• I II'
OFFICE OF THE TOWN CLERK I%IFRA- -
Town of Southold Q C'� .1 Application No. aP(
Judith T. Terry, Town Clerk �Af ' - y
Town Hall, 53095 Main Road OY z 34
I Residential
P. O. Box 1179 5:23 WiPi ; Non-Residential
Southold, New York 11971 O r
Telephone 'Q(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
yyjj l
Fee $ /(J
DATES-/,?3/S-7-5/
•
OWNER NAME: / C¢EAle_P 2 2. L ETT
OWNER MAILING ADDRESS: kS' f EA H !7
-E /O)' )167- 4) Y /l9LgL
OWNER PROPERTY ADDRESS: S,¢ /1/J �
OWNER TELEPHONE NUMBER: ,c1 l - FS
TAX MAP NO. : Section 3 Block 3 Lot 7
CROSS STREET: / AJ/� Z A,v&
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool / New Existing t/
Residential ,/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: .7;AV
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
L Town lerk's Office
DATE: AUG 2 9 IS' E .
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