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HomeMy WebLinkAboutSmith (7) • ,_. 14 4t 40171441^ Town Hall, 53095 Main Road o, '�`� P.O. Box 1179 "�440049: �!' Southold, New York 11971 JUDITH T.TERRY — ®d � •• 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. 890-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner SMITH, WALLACE A. Mailing Address 1 120 FIRST AVENUE Mailing Address 2 City St Zip MASSAPEQUA PARK NY 11762-0000 Property Address 1 8145 PECONIC BAY BLVD. Property Address 2 City St Zip LAUREL NY 11948-0000 Owner Telephone No. 516-798-2030 Tax Map No. section 126.00 block 9 lot 15.000 Cross Street BRAY AVENUE Date Of Last Pump Out 0/00/00 Issue Date: 10/18/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) ii „. OFFICE OF THE TOWN CLERK 1SWFoc �' Fete.„ Town of Southold , c , • ,,,CQ4 Application No. .--o Judith T. Terry, Town Clerk . .fry,,g, ,/ Town Hall 53095 Main Road -_ moi'{; -4 7 Residential Y 2 fit. M ,!i, P. O. Box 1179 ���" � moi, Non-Residential Southold, New York 11971 O4° _ o��i Telephone _ ,( '� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /41,049 DATE /74r- OWNER NAME: ,,.lei A., D. ,,z OWNER MAILING ADDRESS: '00 A7:4?-57- /12eic$4,C-qccil-- l' ,.<„,C- fry- /4262- di OWNER PROPERTv ADDRESS: ' S Cd ,C. a�� -i#W-rde -, "/ 9p' OWNER TELEPHONE NUMBER: (�i�7, .2,}3© JVc.c-J TAX MAP NO. : Section 424 Block 9 Lot lig-- CROSS ' CROSS STREET: (#4Px 3F15 / b.-4sr orr) 8124 PPP TYPE OF SYSTEM: Septic Tank New Existing Cesspool 17 New Existing Residential V Non-Residential DATE OF PREVIOUS PUMP-OUT: .Uwe /9P2' 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.) / - /a / i., Siew,7 . e of Applicant RECEIVED BY: , / ,REcTo g___ e 67- - n CI "rk's Office DATE: 06i 1 G 1a3 ''owTo Veit Southold Rj` I Z®C4 T/® pec' a�-SS,00 4-5 ri c �� Z �E----c IP . . aminiiiirmiplip. WillEiliNEW ., w it •- .: t 3o, ismillEr. . E cm - .A BLVD