HomeMy WebLinkAboutStewart ftsr
Town Hall, 53095 Main Road
�' P44, P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY =;®j ,.. TELEPHONE
TOWN CLERK (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. 822-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner STEWART, ROBERT L.
Mailing Address 1 STEWART, ELIZABETH A.
Mailing Address 2 65 REYAM ROAD
City St Zip LYNBROOK NY 11563-0000
Property Address 1 2102 WESTPHALIA ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 000-593-3944
Tax Map No. section 114. 00 block 7 lot 11.002
Cross Street YOUNGS AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 9/09/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF TME TOWN CLERK
Town of Southold 0•� ry COG Application No.
Judith T. Terry, Town Clerk F k, y
Town Hall, 53095 Main Road i";% : < Residential
P. _O. Box 1179 cr3 -,� ,, hiz Non-Residential
Southold, New York 11971 O '-** 45:'‘:*?"
Telephone `ge.
•
(516) 765-1801
TOWN, OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ,P,,2-7.' _
Fee —
DATE 9 1/Y
OWNER NAME: Re b ,-r i . /� kkg,SreJni,-r
OWNER MAILING ADDRESS: ll Sp oe L yiti �- 0 k
/1-/ I i' /
OWNER PROPERTY ADDRESS: Z/ 0 W -e S T-(4
OWNER TELEPHONE NUMBER: -5. 9 3 J3'
TAX MAP NO. : Section j/ j71
7 Block ! / Lot
CROSS STREET: i6- y4✓j�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: 4/'ej/6/�j,/47
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.)
4-1,;,/-- i ii(-K-ez,v-
Signature of Applicant
RECEIVED BY:
REcciftn Clerk's Office
DATE: SEP og vee, .
Tenn Clerk Southold
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