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HomeMy WebLinkAboutStiber I ��.I o'cilf 9 � r il..1/ Town Hall, 53095 Main Road . un `� �� P.O. Box 1179 ."� Southold, New York 11971 JUDITH T.TERRY 1g�I 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. 739-R Residential X Non-Residential Fee $ 10. 00 Septic Cesspool X New Existing X Name Of Owner STIBER, SEYMOUR Mailing Address 1 P.O. BOX 1624 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 3130 MINNEHAHA BLVD. Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-1014 Tax Map No. section 87. 00 block 3 lot 37.000 Cross Street OWAISSA Date Of Last Pump Out 0/00/00 Issue Date: 6/23/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) r OFFICE OF THE TOWN CLERK ocl\f FULA/ Town of Southold CQ -- , Application No. Judith T. Terry, Town Clerk Town Hall, 53095 Main Road o { Residential P. O. Box 1179 cn 1Y 4 4a r Non-Residential ^, Southold, New York 11971 4 ® ��` Telephone _- ' (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE 6) - Z3^ ES) OWNER NAME: 5 Ewe) 2 T J5 E.1- OWNER MAILING ADDRESS: P O 3 D)c- l Z ,sbv i DN-y 1 19 ? OWNER PROPERTY ADDRESS: 3 ) 3c) Jl I N N E 1d A H A- $ L V) 5 v i rl © >.D 1\-1. ) 1 7 -7) OWNER TELEPHONE NUMBER: 7 b S / C ) 1/ TAX MAP NO. : Section/000 5 2 Block 3 Lot 3 .7 CROSS STREET: O W Ar ) 5 5 A TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: 5-- LOCATION 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.) OF • lignature of Applicant RECEIVED BY: Ayz_d62_ ft a E; Town C ark's Off ice DATE: Jo ZS 19,69 r , � 0 .70 n� i 3 /3 0 NE,1/4J,9-)-1,.-gLv�