HomeMy WebLinkAboutRaynisJUDITH 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. 1849-R Residential X
Fee $ 10.00 Septic
New
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
Non -Residential
Cesspool X
Existing X
RAYNIS, DONALD AND KATHLEEN
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1750 SMITH ROAD
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PECONIC NY 11958-0000
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1750 SMITH ROAD
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PECON I C NY 11958-0000
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516-734-6149
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98.00 block 3 lot 20.000
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INDIAN NECK LANE
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0/00/80
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: 2/19/92 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
r
O,FF1QE OF TlAEa T6WN 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
TOW -N OF SOUTHOLD
Application No. l �y
$10.00 - Residential
$25.00- Non -Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
OWNER NAME: -
OWNER MAILING ADDRESS: / JD
Y OWNER PROPERTY ADDRESS:
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DATE -L�- Xf /% % L
OWNER TELEPHONE NUMBER: 49t, WoZ�-6,J"_7 L
TAX MAP NO.: Section d Block 6_3 Lots
_ CROSS STREET:
TYPE;,OF SYSTEM:- Septic Tank New Existing
Cesspool r New Existing jC
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.)
Signat a of App 'cant
R E C E I V•E D: B Y: ✓/�N`�''—�
ow Clerk's Office
DATE:
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FILED MA Y 27, 1913 FILE NO. 351
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TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
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Scale 1" 30"
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90-258