HomeMy WebLinkAboutSidor (3) Town Hall, 53095 Main Road
P.O. Box 1179
s Southold, New York 11971
JUDITH T.TERRY - '��' TELEPHONE
TOWN CLERK (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. 650-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner SIDOR, JOHN JR.
Mailing Address 1 3980 WICKHAM AVENUE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 3980 WICKHAM AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4495 '
Tax Map No. section 107. 00 block 10 lot 1. 000
Cross Street MARY'S ROAD
Date Of Last Pump Out 0/00/00
74/
Issue Date: 3/19/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 'COFeu( '
Town of Southold �� CQ al , Application No.
Judith T. Terry, Town Clerk 4 CP; y
Town Hall, 53095 Main Road 8 �,- s. 7 Residential
P. O. Box 1179 Non-Residential
Southold, New York 11971 O�`4 - 0 ��`�
Telephone :�( �� '�,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for - - --"
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ JO
DATE Varcjhl riga
1-0 /1/0 S dOWNER NAME: ( OV ri
OWNER MAILING ADDRESS: 3 ? ' U co lck ti ctm A VE
MATT u-c(c 4) y
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: c/4 - .19-5) - 4-1
TAX MAP NO. : Section 109 Block 10 Lot
CROSS STREET: HaI(LS ani
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: (- f) ,� 19 i P
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.)
Signature of pplicant
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RECEIVED BY:
Town Clerk's Office ,
DATE:
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