HomeMy WebLinkAboutRaymondJUDITH T. TERRY
TOWN CLERK
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. 656-R
Fee $ 10.00
Name Of Owner
Mailing Address 1
Mailing Address 2
City St Zip
Property Address 1
Property Address 2
City St Zip
Owner Telephone No.
Tax Map No. section
Cross Street
Date Of Last Pump Out
Issue Date: 3/22/88
Residential X
Septic
New
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
TELEPHONE
(516) 765-1801
Non -Residential
Cesspool
Existing
RAYMOND, GRACE F.
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RR 1, 5795 ROCKY POINT ROAD
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EAST MARION NY 11939-0000
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5795 ROCKY POINT ROAD
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EAST MARION NY 11939-0000
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516-477-1569
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21.00 block 1 lot 3.000
AQUAVIEW AVENUE
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9/04/85
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Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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 S'OUeT'`H2OLD
;Application No.
R`esidential
Non -Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT,
APPLICATION
for
OPERATI.ON PERMIT
SEPTIC STANK or CESSPOOL
Operation Permit No.
Fee $
OWNER NAME �• R,/ L
OWNER"MAILING ADDRESS:
OWNER x PROPERTY ADDRESS:
OWNER TELEPHONE NOMBER: �'/6 `.M 114.7 !Z �, q
1
TAX MAP NO.: Sectjp" 24 `_3 Block Lot
CROSS' STREET: AQ VL-E:uj AU •
TYPE OF SYSTEM: Septic Tank ✓ New Existing 1/
Residential 'Non -Residential
DATE OF PREVIOUS PUMP -OUT: -see
r t La.l
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.)
Cesspool I 11-�' New
Existing
Signature
C-:5) �)
RECEIVED BY: 4-1_Lc9c, a-- 3LC��
RECEMffown CI k's Office
DATE: MAR 221988
Town Clefk Southold
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plicant
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