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HomeMy WebLinkAboutSwiskey 1ZyTiz � ��i+l avu u13'k �7� Town Hall, 53095 Main Road P.O. Box 1179 s2 , ���i9 Southold, New York 11971 JUDITH T.TERRY �T `zs' , ��� FAX(516)765-1823 TELEPHONE(516)765-1801 TOWN CLERK 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. 1432-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner SWISKEY, JOHN Mailing Address 1 BAYVIEW ROAD Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 BAYVIEW ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-3683 Tax Map No. section 78.00 block 2 lot 18.1003 Cross Street BAYWATER AVENUE Date Of Last Pump Out 0/00/00 Issue Date: 4/02/90 Judith T. Terry Southold Town Clerk (TOWN SEAL) ii „. • OFFICE OF THE TOWN CLERK 'cwVFG Town of SoutholdC'QG� Application No. P/362.)Judith T. Terry, Town, Clerk �rX 4 w Town Hall, 53095 Main Road -� ; :r -'� $10.00 - Residential P. O. Box 1179 cn :rte . ;;' $25.00 - Non-Residential Southold, New York 11971 Telephone :Oi '1 ', (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT• APPLICATION OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE :V/67' 'OWNER NAME: 0 D k W OWNER MAILING ADDRESS: 7 ,S1.0'14J jf';r E & 1Y I / fi Ld ✓ // / 77 OWNER PROPERTY ADDRESS:_h .i' _ qfVf �� 1Rd, 6'6u71/ /d OWNER TELEPHONE NUMBER: TAX MAP NO. : , Section © 21 Block Lot /7 CROSS STREET: TYPE OF SYSTEM: Septic Tank - New Existing I - Cesspool New Existing 3 Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: -3/ 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.) Per&-.00' - -110 Ar i' Signat a of Applicant RECEIVED BY: Town Clerk's Office DATE: ,"..%) ... I. V .14k3 1• 5- ilLt(1-' • 4 _ -410 tiV ,