HomeMy WebLinkAboutRayJUDITH T. TERRY
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3015-R
Fee $ 10.00
Residential X Non -Residential
Septic Cesspool X
New Existing X
Name Of Owner RAY, JAMES
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Mailing Address 1 C/O C. MARTIN
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Mailing Address 2 310 ORCHARD STREET
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City St Zip NEW SUFFOLK NY 11956-0000
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Property Address 1 310 ORCHARD STREET
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Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
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Owner Telephone No. 212-548-6624
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Tax Map No. section 117.00 block 7 lot 5.000
Cross Street JACKSON STREET
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Date Of Last Pump Out 0/00/00
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
'Telephone (516) 765-1801
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Issue Date: 5/07/93 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
31
OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
Application No.�C3`�U
$10.00 - Residential ✓
$25.00 - Non -Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Operation Permit No.
Fee $ a
OWNER NAME:
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
-DATE -- -_. _ / ____
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS.:_3z0 O C/w2.0 J7�
OWNER TELEPHONE NUMBER:
TAX MAP NO.: Section Block % Lot
CROSS STREET: �j�6rSo
TYPE -OF SYST•EM-: Septic Tank New Existing
.Cesspool / New Existing
Residential l/ Non -Residential
DATE OF PREVIOUS PUMP -OUT: r
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 t o Applic t
RECEIVED BY:
Town Clerk's Office
DATE :
l
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