HomeMy WebLinkAboutPollock ®4VIllI��®G:
JUDITH T. TERRY . : Town Hall, 53095 Main Road
TOWN CLERK P.O.►PT+ Box 1179
REGISTRAR OF VITAL STATISTICS to `�` �� Southold, New York 11971
y +, Fax (516) 765-1823
MARRIAGE OFFICER `: ® ®�` •
� 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. 3146-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner POLLOCK, DAN AND LIDYA
Mailing Address 1 P. O. BOX 207
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1230 RUCH LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5824
Tax Map No. section 52.00 block 2 lot 36.000
Cross Street ROUTE 48
Date Of Last Pump Out 0/00/00
Issue Date: 11/17/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
` IIS
OFFICE OF THE TOWN CLERK ���F'O(�.�'=
Town of Southold 4 $ CQ ' Application No. 3 /S.
Judith T. Terry, Town Clerk . � Lx-
Town Hall, 53095 Main Road -'� $10.00 - Residential
-
P. O. Box 1179 � � ' hi ; $25.00 - Non-Residential
Southold, New York 11971 �y� _ �0'���`
Telephone ': ( y�
(516) 765-1801
• TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
..APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ (C)
DATE H( C et 3
OWNER NAME: .7 lD`' t._k_coe
OWNER MAILING ADDRESS: Peel( 2-09
t -1
OWNER PROPERTY ADDRESS: t-2_,3.10 Ro �gAtJ
OWNER TELEPHONE NUMBER: "`S-CtC2- - -
TAX MAP NO. : Section Block Lot
CROSS STREET: DX.A- 42(
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: IQ '. '
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:
Town Clerk's Office
DATE:
i, -. i. 1230 c.
---R \,:st., ..,k4,
.
,---2 .
--
/
1 tt
i
/
/
N it
I
-- 1.
I /
/
1N1.
/ 1
N* '
VI ' !liar:1"I
I
'''/ .
Nit
41 -...-
...„ . t .
In , / '
,..._-----2
[t
/
If
r
!‘ /
(
-%
,---..., ...-i
\
L....---)
lif
/ \ .
\--)
/ .1
/
1
I,,,,,,,,i•
\ /
0-- (..__
---,
N.,
0 -
i , ..
I
I • N „
•
...„...... .
1 ,
''''''''.4...........-.........—,,
0 0 SE
,,,,,,,,,,,,,,,,...c...4-'..s,•,. ....T.4..-actwAs-...x.?,,,4
)
/I/\
*
i
— -
- .,.....,4