HomeMy WebLinkAboutSimon Ow II
41\0� F U,C,oG
Town Hall, 53095 Main Road
�� P.O. Box 1179
�Q1 * `At001 Southold, New York 11971
JUDITH T. TERRY ������'I" 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. 1075-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SIMON, MICHAEL AND SHANNON
Mailing Address 1 320 NORTH VILLAGE AVENUE
Mailing Address 2
City St Zip ROCKVILLE CENTRE NY 11570-0000
Property Address 1 MAIN STREET
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-734-7237
Tax Map No. section 117.00 block 9 lot 28.001
Cross Street SECOND STREET
Date Of Last Pump Out 0/00/00
Issue Date: 4/05/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFF1e.E OF THE TOWN CLERK c31FUJ.•'-
Town of Southold � CSG; Application No./67�
Judith T. Terry, Town Clerk ' .r=e �‘'� Residential 0�
Town Hall, 53095 Main Road a '� .
P. O. Box 1179 �..,�: ,;��r;!�.'° �, Non-Residential
Southold, New York 11971 4 ®__ jO �`
Telephone __ ®( II
4P)
765-1801 ,,.
TOWN OF SOUTHOLD
k = - SOUTHOLD WASTEWATER DISPOSAL DISTRICT
MAR 2 1989 APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
'Fee $ / 0, 0O
DATE r i ,44 i?‘ of/
OWNER NAME: A/ /G/_46.4_ 1214-et S'Iler ceift /v- �l• -4)
OWNER MAILING ADDRESS: . U 11,1-(46-G / tJ .
°R-okkv,Ile Ce.,44-,e, I\i y /lf7O
OWNER PROPERTY ADDRESS: << , ,,. ' !W S.-MP E-E-z -81-S ecoyo c . ( :E', corker.)
OWNER TELEPHONE NUMBER: 7311 '7.137 rf7 6- --salh,
TAX MAP NO. : Section 11 7 • 0 0 Block D9, 0 0 Lot b...13. 0 0 •
CROSS STREET: 5e-Co N,p cr4 E
TYPE OF SYSTEM: Septic Tank
New Existing
Cesspool V New Existing
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.)
WC4ae.a. SL46'14
Signature of Applicant
RECEIVED BY: (/v ' •
Town Clerk's Office
DATE: / -
1��
I SURVEYED FOR.-
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LOCATED AT A,../E1.-V ...5-4/A--A--oz. , TOWN OF �our,i../oLL) , SUFFOLK COUNTY N.Y.
LOT •
MAP OF .C��SC°e/BEQ 4-,°e0•LD'E,€'7"--y- ...---- (5°---"-------------------,—C-;. CLK. NO. FILED
SCALE 1" 20' :
SUFFOLK CO. TAX MAP DATA.- .[cCO/l/® ST.eEET
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DIST./l, O SEC. //ZOO / 5-c).5'_ ,;:1)-1 .
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SHOULD I.O1 £E USD FOR •
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_ - SURVEYED SEPT 8, 19 BY
- - WILLIAM R. SIMMONS JR.
PLO BOX 377
if\-- JAMESPORT, L. I., N. Y. 11947
I fi • " �`. r ig a��,Gy FILE NO. �/'9..� PAGE 24 GRID,-.39' ,.
DRAWN BY ,:
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