HomeMy WebLinkAboutStarzee Cr-
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��` Town Hall, 53095 Main Road
`�, P.O. Box 1179
Vr.'/® � '��. Southold, New York 11971
JUDITH T.TERRY � FAx(516)765-1823
TOWN CLERK TELEPHONE(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. 1116-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner STARZEE, FRANK AND BARBARA
Mailing Address 1 405 YOUNGS AVENUE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 405 YOUNGS AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8296
Tax Map No. section 114.00 block 10 lot 29.000
Cross Street PINE STREET
Date Of Last Pump Out 0/00/00
Issue Date: 5/22/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 'c�1FDC,r /
Town of Southold �� ea -- Application No./Y��
Judith T. Terry, Town Clerk >Y�j. .''vResidential
Town Hall, 53095 Main Road
P. O. Box 1179 ' � ` �� i z Non-Residential
Southold, New York 11971 O �M
Telephone = jJgd
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 1.6 W - -
DATE �- I
OWNER NAME: '(1\63,\/ A_hAk )p 01 4 6"L,
OWNER MAILING ADDRESS: 45 1-bu &C,76 k%. .
OWNER PROPERTY ADDRESS: nr‘ •
OWNER TELEPHONE NUMBER: AIX- K19
TAX MAP NO. : Section 13 ® Block )14' - 10 Lot- 1
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential V 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.)
L1/41114A___ •
Signature of Ap.licant
RECEIVED BY: (4i...1,4414_„
Town 'Clerk's O •five
DATE:
22 198
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