HomeMy WebLinkAboutRaffel JUDITH T. TERRY ` Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �® o / Fax (516) 765-1823
-v.4/fin Telephone (516) 765-1801
40"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1885-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner RAFFEL, JAMES AND MARIA
Mailing Address 1 RD #2, BOX 195 LESLIE ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 LESLIE ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7874
Tax Map No. section 97.00 block 4 lot 15.000
Cross Street BAY AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 4/21/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i
1,,C`8 OF THE TOWN CLERK ac�OFOL' -
Town of Southold A Application No./gccj
Judith T. Terry, Town Clerk .` ` '.,
" .G I $10.00 - Residential
Town Hall, 53095 Main Road i x�,
P. 0. -Box 1179 mss® .1 �` $25.00 - Non-Residential
Southold, New York 11971 0 „F- _0�
Telephone _ i
41
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10.00
DATE
OWNER NAME: JArne.5 ! fv1nklA- (ZflrFt.L
OWNER MAILING ADDRESS: 41 1 J&V )95 L.E5L(E. RD ,
C,OTC- +OGC,E) ,y 199a6
OWNER PROPERTY ADDRESS: .5 i't E
OWNER TELEPHONE NUMBER: 5I6-7311-- 874
TAX MAP NO. : Section Block ° 14. Lot /5
CROSS STREET: $.e.Q, pQ ��-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool - New Existing
Residential k 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.)
Signa 4'e of Applicant
RECEIVED BY: V.; . �.
lerk s 0 ice
DATE: VilD 2' 1010
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