HomeMy WebLinkAboutPrince (2) Ai)). ,`,c,7*Itv,`*;;A
: "� Town Hall, 53095 Main Road
40,4
P.O. Box 1179
=___ �� � Southold, New York 11971
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JUDITH T.TERRY
��'" FAx(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OE VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1148-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PRINCE, HENRY W.
Mailing Address 1 P. O. BOX 684
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 TRAVELER STREET
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2274
Tax Map No. section 60.00 block 2 lot 1 .000
Cross Street YOUNGS AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 6/13/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
.
OFFICE OF THE TOWN CLERK S�FFO�
Town of Southold C'�G� , Application No. pcLY
Judith T. Terry, Town Clerk �`
Town Hall, 53095 Main Road „ ' - $10.00 - Residential
P. O. Box 1179 '40 �4 ;' $25.00 - Non-Residential
Southold, New York 11971 O ti . • *$
Telephone ,( y► '/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
•
DATE
OWNER NAME: /6® �
OWNER .MAILING ADDRESS:
J � - • � �. r is art
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 7 .2-2- 77/
TAX MAP NO. : Section e) Block _ Lot =
CROSS STREET: ,
TYPE OF SYSTEM: Septic Tank 4 New Existing y
Cesspool 7 New Existing
Residential j/ Non-Residential
x�S �
DATE OF PREVIOUS PUMP-OUT: ��?-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.)
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Sign& re of A•plicant
RECEIVED BY: MEW
Town Clerk's Office
JUN 13 19b
DATE:
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