HomeMy WebLinkAboutPrizeman (2) 44
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK G
Fri
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS tin Southold, New York 11971
MARRIAGE OFFICER yQ O�.., Fax (516) 765-1823
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It,. ' 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. 3132-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner PRIZEMAN, JOHN AND DIANA
Mailing Address 1 131 HICKS STREET
Mailing Address 2
City St Zip BROOKLYN HEIGHTS NY 11201-0000
Property Address 1 1835 PARK AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 718-624-0386
Tax Map No. section 123.00 block 2 lot 34.000
Cross Street BUNGALOW LANE
Date Of Last Pump Out 0/00/00
Issue Date: 10/14/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
III
OFFICE OF THE TOWN CLERK c3\\FFour
Town of Southold 0 CQG Application No. I
3
Judith T. Terry, Town Clerk . ' , �:,
Town Hall, 53095 Main Road u $10.00 - Residential
P. O. Box 1179 tat ' ��
��,,.• $25.00 - Non-Residential
Southold, New York 11971 O ��
Telephone Ojf- `it•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLi C!\T:ON
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ )Q •
DATE '' °VISE' / 993
OWNER NAME: T o J`} N c' DIANA Pg I ZE/ 1A A)
OWNER MAILING ADDRESS: 131 Hick-5 5T1 FEI
13Kootc-i_w
OWNER PROPERTY, ADDRESS: 663 5- P,4Ric A-Uf
1��4�nru�ec /v"‘I s / 95
OWNER TELEPHONE NUMBER: 7/(3 -2_4 0 3 76
TAX MAP NO. : Section (`z.3 Block 2- Lot 34
• CROSS STREET: 5O/UQALO w L-A-NE
TYPE OF _SYSTEM": Septic"Tank v ' New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
1A4 .i./AL[.0 A
• Signature of App 'i ant
RECEIVED,..- BY: -_.
Town Clerk's Office
DATE:
PIS T loco sec 12,3 g z oGlc 2 z- or 3+ -
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c11.101.1. UNAUTHORIZED ALTERATION a=MK
TO THIS SURVEY IS A VIOLATFOM OF
SECTION 72D9 OF THE NEW YORK STATE
/ y^ EDUCATION LAW
N.85'41.5-D"E.. - 1 40.0 COPIES OF THIS SURV;Y MAP NOT BEARING
THE LAPD SU VEYOR'S iH.._D SEAL OR
EMBOSS,D SEAL SHALL NOf BE CONSIDERED
TO BE A VALID R,UE COPY.
GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE,'EPSON FOR WHOM THE SURVEY,
IS PREPARED,AND ON H'S BEHALF TO THE
TITLE COMPANY,OOVER,EMENTAL AGENCY AIR
LENDING INSTITUTION LISTED HALOS,AND
O TO THE ASSIGNEES OF THE LENDING INSTI-
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C TO ADDITIONAL INSTITUTIONS OR SUBSEQUEIIC
OWNERS.
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