HomeMy WebLinkAboutStearns '
` 'lµ r 'down Hall, 53095 Main Road
;cam®'- '' 1 P.O. Box 1179
� ® Southold,New York 11971
JUDITH T.TERRY — = r'�/`�" 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. 1127-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner STEARNS, DOUGLAS
Mailing Address 1 STEARNS, J. ELIZABETH
Mailing Address 2 1885 SIGSBEE ROAD
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1885 SIGSBEE ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4049
Tax Map No. section 144.00 block 2 lot 16.000
Cross Street PECONIC BAY BLVD.
Date Of Last Pump Out 0/00/00
Issue Date: . 5/30/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I
OFFICE OF THE TOWN CLERK a*�CFD
Town of Southold �� deo Application No. Pe?-7
Judith T. Terry, Town Clerk =
Town Hall, 53095 Main Road , . ' � r l Residential
P. O. Box 1179 cry . ,„.,+ :ir
.,� 4 � Non-Residential
Southold, New York 11971
14
oma,,
Telephone O( ,
(516) 765-1801
TOW OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
PPLICATION
•
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE Me., 2.6 ( 19
OWNER NAME: (A.G 6,i/S S'TE-,q S O id tZ O� SAthvy Vt S
OWNER MAILING ADDRESS: `085 J7458E Ri) .
,v y /03-e
OWNER PROPERTY ADDRESS: gg.s- f/cra,st RD.
"1.77-/7ceG4‹ ,U Y
OWNER TELEPHONE NUMBER 02q 8 - 4054 j' {
TAX MAP NO. : Section 0 00 Block / 144 Lot 2-f(
CROSS STREET: {eCOw(C, ,d/9Y
TYPE OF SYSTEM: Septic Tank / New Existing
Cesspool I New Existing
-ov`+- - Si�nct, wevesidential Non-Residential
OWN ---DATE OF PREVIOUS PUMP-OUT: MAVC,I/1 al , (cm
yi6
OCATION 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.)
�.ignature • Applicant
RECEIVED BY:
Town Clerk's Office
DATE: •
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