HomeMy WebLinkAboutSterling w '
tel'a\DL �l`-
tsb Town Hall, 53095 Main Road
; P.O. Box 1179
_ ®� Southold, New York 11971
JUDITH T.TERRY FAX(516)765-1823765
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. 1147-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner STERLING, PETER & GEORGIENNE
Mailing Address 1 1085 HARBOR LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1085 HARBOR LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5495
Tax Map No. section 97.00 block 6 lot 14.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/13/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
t
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OFFICE OF THE TOWN CLERK cuFFO(,(- = , /J
Town of Southold �� %--_, Application No. ///
Judith T. Terry, Town Clerk ►
53095 Main Road y -< $10.00 - Residential
Town Hall, � - •
P. O. Box 1179 cn r4-,7; � h� � � $25.00 - Non-Residential
Southold, New York 11971 Oo _
Telephone °( 4rt '6
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
$ /0 O.P.
Fee
DATE 4//1/g7
OWNER NAME: e; e 6/4.
OWNER MAILING ADDRESS: p f 4;4 = o/L e
eul—Cifr NO/ ///3r-
OWNER PROPERTY ADDRESS: /4;dUC
° OWNER TELEPHONE NUMBER: c'// -
TAX MAP NO. : Section g1 Block (,P Lot / K
CROSS STREET: 4741//✓' ° /,
TYPE OF SYSTEM: Septic Tank New Existing /
Cesspool / New' Existing �/
Residential t/ 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.)
Signature / • pplicant
RECEIVED BY:
Vp vn Clerk's Office
DATE: JUN 13 11989
76th Cid tom
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lA Y> SECTION 7209 OF THE NEW.YORK SiATE
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