HomeMy WebLinkAboutSpencer IP t /I FOUr
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JUDITH T.TERRY , ; Town Hall,53095 Main Road
TOWN CLERK elgo t P.O.Box 1179
REGISTRAR OF VITAL STATISTICS `� , Southold,New York 11971
MARRIAGE OFFICER ��� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER .t `P,i�� Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3347-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner SPENCER, BETTY
Mailing Address 1 P. O. BOX 155
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 525 ORCHARD STREET
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-736-3005
Tax Map No. section 25.00 block 2 lot 20.011
Cross Street VILLAGE LANE
Issue Date: 6/02/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• •ice
O��FICE "OF THE TOWN CLERK
'c�VFFO(,��"`
Town of Southold �� CQG',, Application No. 33 y7
Judith T. Terry, Town Clerk ��� • y
Town Hall, 53095 Main Road
.G $10.00 - Residential
P. O. Box 1179 to , ' $25.00 - Non-Residential
Southold, New York 11971 O *.$
Telephone 0 I .°
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
' APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE j lnq
OWNER NAME: C3 ( i-iN4 S 1INcEtt •
OWNER MAILING ADDRESS: 19. Of ID`F tc5
o eKt N; ` q5-1
OWNER PROPERTY ADDRESS: C).-Srs OikairlAti S r
fits 1— N s
OWNER TELEPHONE NUMBER: 13(t —300(
,
TAX MAP NO. : Section 02,5/ Block v2• Lot cQ O
CROSS STREET: V 11-1-06-E._ %-trUi-`f
TYPE OF SYSTEM: Septic Tank New Existing
'' .w ;. , .- ; Cesspool V New Existing
Residential V Non-Residential
M LOCATION MAP: Must be attached hereto before permit may be issued.
11 C;E Po,,L. (Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
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v _ ��� Si•natu/(of Applicant
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RECEIVED BY: 'V ' '
To . Clerk's Uffice .. -
DATE: • : ,
it
. JUN 2 1995 i
sown Clerk SOMA