HomeMy WebLinkAboutPreston 1'
at i �' Town Hall, 53095 Main Road
P.O. Box 1179
_ ® 1,,,, Southold, New York 11971
7- -4 EE1JUDITH T.TERRY J' / 765-1823
TELEPHONEFAX( )16)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. 1065-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PRESTON, RUTH
Mailing Address 1 2 MIDDLETON ROAD
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 2 MIDDLETON ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1092
Tax Map No. section 33.00 block 5 lot 18.000
Cross Street NORTH ROAD
Date Of Last Pump Out 5/20/78
Issue Date: 3/30/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK cOF
Town of Southold A - Application No. /6 (1�
Judith T. Terry, Town Clerk �` 2,41. _ �a3 y
Town Hall, 53095 Main Road Residential
P. 0. Box 1179 . :ri _:• i Non-Residential
Southold, New York 11971 04:••,•
Telephone •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE ,/ / c
• OWNER NAME: fit/-h ter
OWNER MAILING ADDRESS:o - i ) „ilk;
c---v1 v% // q'S'
OWNER PROPERTY ADDRESS:,Z , jive/z„
iv //9se
OWNER TELEPHONE NUMBER: Y — /0 yZ
7
TAX MAP NO. : Section A 53 Block3 - `�- Lot / r ••
CROSS STREET: C
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool A/ New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: „I-- )e' - 7/
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:
Olown Clerk's Office
DATE: 34oh?
i
I
N/�nyl/'D 9
/1
rr 8/('