HomeMy WebLinkAboutSuprenant tll/Y,I/�17%�
JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK F ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` .�� Southold, New York 11971
MARRIAGE OFFICER O> Fax (516) 765-1823
0' Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Qperation Permit No. 1915-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner SUPRENANT, RONALD W.
Mailing Address 1 P. O. BOX 201
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 62445 NORTH ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-2959
Tax Map No. section 40.00 block 1 lot 6.000
Cross Street CHAPEL LANE
Date Of Last Pump Out 0/00/00
Issue Date: 6/01/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK ��OFU -
Town of Southold �� CQG Application No. /WS.--
Judith T. Terry, Town Clerk ,�'' gt �
Town Hall, 53095 Main Road `' .< $10.00 - Residential
P. O. Box 1179 cn 3 � . ;' $25.00 - Non-Residential
Southold, New York 11971 O ® `r- *-
Telephone 490'41%
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. v I
Fee $ /•U '
I Y
DATE /P/L, /3> /99,1_
OWNER NAME: RC/UM-6 . • �UfPOZ.4F MA) 7'
OWNER MAILING ADDRESS: Po a )( 20 '
1z `vgO,z2 i/9 v y
OWNER PROPERTY Y ADDRESS: 6 x f 9/2 I2
/-c .ups-aresr- A) ) //9vG!
OWNER TELEPHONE NUMBER: 174 --)7 �a9J 7 / 9ac _ /9y/ A/65-6
TAX MAP NO. : Section 90 Block l Lot 6
""CROSS STREET: C
TYPE .OF: SYSTEM: Septic Tank K New X, Existing
Cesspool x New X Existing
Residential 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.)
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Signature o Applicant
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RECEIVED•.BY: '
•
REcoviern Clerk's Office •
DATE:` JUN 01 ,
Town Clerk Mobthbfd