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JUDITH T. TERRY ,O Town Hall, 53095 Main Road
TOWN CLERK T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
y Fax (516) 765-1823
MARRIAGE OFFICER ® ®� •
-1D Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3032-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SNYDER, DOROTHY
Mailing Address 1 17 FAIRLAWN LANE .
Mailing Address 2
City St Zip CENTEREACH NY 11720-0000
Property Address 1 150 FIFTH STREET
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-732-6671
Tax Map No. section 7.00 block lot
Cross Street CLARK STREET
Date Of Last Pump Out 0/00/00
Issue Date: 5/21/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK •• FO ��'
Town of Southold y -:• e, Application No(30
47;Judith T. Terry, Town Clerk r? .
Town Hall, 53095 Main Road -<
$10.00 - Residential
P. O. Box 1179 cr, . ._ $25.00 - Non-Residential
Southold, New York 11971 Off® `FY' s'' �•
Telephone (,� 't,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /a• O l�
DATE ,/ ' 779,3
OWNER NAME: 1)e.7 i SN y/,7/---
OWNER MAILING ADDRESS: / 7 A,...577/ z /1?- .F
"71 � �d ,'y 7..72)
OWNER PROPERTY ADDRESS: - /fib"
/2F --X/0
OWNER TELEPHONE NUMBER: �/�
TAX MAP NO. : Section G 7 Block e4S Lot 7
f _
CROSS STREET:
TYPE OF:SYSTEM: Septic Tank New Existing
Cesspool , 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.)
c
Sig -ture of Applicant
RECEIVED--BY-: - -
Town Clerk's Office
DATE:
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ro this survey is o violation of .: : ,r -
i Ecction 7200 of the Now York State
Edcceticn Law. •T,:•••""-__ft
copses rf thip survey mop not bearing '4
the lend surveyor's Inked seal or ' •;4�'?'
embossed seal she!!not be considered
4o be v eclid true copy. _ ,=.j..''',:k
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Guarantees harkened hereon shell ruts ' ,'t Ili r
only to the person for whom the sunray ' '•1` 'AN,' .
is prepared and on his behalf to the
title company,governmental eancy and ,-'
lending institution Hated hereon and 1
to the se:lenses of the lending IneW : .'.`y •', ` ' ,.
action.Guersntesa are not transferable 1
to ccniitionai institutions or subsequent
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