HomeMy WebLinkAboutSperling JUDITH T. TERRY z Town Hall, 53095 Main Road
TOWN CLERK v ' P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New.York 11971
� Fax (516) 765-1823
MARRIAGE OFFICER - ® Ace'
',y®1 + r� .� 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. 3128-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner SPERLING, ESTHER L.
Mailing Address 1 P. O. BOX 2
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 1115 MAIN STREET
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0567
Tax Map No. section 34.00 block 1 lot 13.000
Cross Street COUNTY ROAD 48
Date Of Last Pump Out 0/00/00
Issue Date: 9/27/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK cOFOur`,D._ Application No. �
Town of Southold �� ,
Judith T. Terry, Town Clerk . j' ' ►''�
Town Hall, 53095 Main Road =- A $10.00 - Residential
p. O. Box 1179 u' < may' ; $25.00 - Non-Residential
Southold, New York 11971
Telephone 1#0,(.'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
0
Fee $ �Q
DATE Seert t g�, 17/3
OWNER NAME: ,L $T,P(/' A, .Spm)- Ots
OWNER MAILING ADDRESS: fag Sr; 9,7 g
C-s tee.itioo r7 iY, /- l irw
OWNER PROPERTY ADDRESS: / /lS� mdhr 5r•
OWNER TELEPHONE NUMBER: 1/4-1-/77- 65-‘7
TAX MAP NO. : Section g4/( Block / Lot l
CROSS STREET: Hpr(li {, (gvny f{664c( ��
TYPE OF SYSTEM: Septic-Tank New Existing
Cesspool New Existing
Residential I/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: (a,�,44,,t 06, /f3
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.)
Signature of pplicant
RECEIVED` BY: . Ki
Towns Office
ROM
DATE:
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