HomeMy WebLinkAboutSobieray Town Hall, 53095 Main Road
P.O. Box 1179
® � �� Southold, New York 11971
JUDITH T.TERRY =� �rl, 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. 796-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SOBIERAY, JOHN
Mailing Address 1 BOX 1095, SUNSET AVENUE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 SUNSET AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4048
Tax Map No. section 115. 00 block 3 lot 6. 000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date; 8/22/88 - Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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• Se.
OFFICE OF THE TOWN CLERK �
Town of Southold
��, Application No.
Judith T. Terry, Town Clerk �� Ave'go
Town Hall, 53095 Main Road sV ..0 Residential
p. O. Box 1179 v' ` . `� ? i ; Non-Residential
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
fnr
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10
DATEAP f / (f)--/
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OWNER NAME: '=d)� jc2)1-)t el'a y
OWNER MAILING ADDRESS: Sce lir s,.e 7-- Li .e Q Bc,x 1®q`e,
OWNER PROPERTY ADDRESS: Soh .e t /- u
ii)f) ct.71- C1-1 N.y,
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section l/, Block Lot
CROSS STREET: --7) (q_e— Pe-er&4�)
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: C/LI
LOCATION M
AP: Must be attached hereto efore - emit may� be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
Signature of App/Int
RECEIVED BY: , e
REcE.11r .wn erk's 0 fce
DATE: ryllG 22 19
Tion C• R .111`ads
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