HomeMy WebLinkAboutRascoe 001 OW
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Town Hall, 53095 Main Road
P.O. Box 1179
. �et Southold, New York 11971
JUDITH T.TERRY .' TELEPHONE
TOWN CLERK -'71 f '04,Ace�,4,/I� (516)765-1801
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. 765-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner RASCOE, RUTH M.
Mailing Address 1 1305 BAY HAVEN LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
t Property Address 1 1305 BAY HAVEN LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3490
Tax Map No. section 88. 00 block 4 lot 37. 000
Cross Street MIDWAY
Date Of Last Pump Out26/7/6/30
Issue Date: 7/19/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK cw�FO(,(��'% 7 �
Town of Southold Q C'��"_, Application No.
Judith T., Terry, Town Clerk �� f; 4, y
Town Hall, 53095 Main Road ' `. ,°; -� 7 Residential
P. O. Box 1179 cry * i �, Non-Residential
Southold, New York 11971 ® f="
Telephone
(516) 765-1801 1
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ !®; b
DATE 17 1o_ NctgF
OWNER NAME: (,Ak\, C�, qa5
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OWNER MAILING ADDRESS: I ) b 5 p,0,„���,re�, 1,,nv1e,.
Sot4 +he1d itcylk
OWNER PROPERTY ADDRESS: S Qw e as At, e_,
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OWNER TELEPHONE NUMBER:
F
TAX MAP NO. : Section s Block Ait Lot 31 '
CROSS STREET: h'Vti,k,bcky
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TYPE OF SYSTEM: Septic Tank New Existing
Cesspool v New Existing I
Residential %/ Non-Residential
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DATE OF PREVIOUS PUMP-OUT: Cn (Alee,\•1 --1 ) \ctg'9,
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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Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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