HomeMy WebLinkAboutMeguin JUDITH T. TERRY ' Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER v, Fax Fax (516) 765-1823
�� ��� � Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3056-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MEGUIN, ROBERT R.
Mailing Address 1 605 LONG CREEK DRIVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 605 LONG CREEK DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-9303
Tax Map No. section 55.00 block 3 lot 25.000
Cross Street LARUEL ROAD/TUTHILL RD. EXT.
Date Of Last Pump Out 0/00/00
Issue Date: 6/29/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
a
OFFICE OF THE TOWN CLERK oS1FDCA/
Town of Southold Application No. 305;6
Judith T. Terry, Town Clerk _
Town Hall, 53095 Main Road '-�
.c 1 $10.00 Residential
P. O. Box 1179 crs ,%-z:"1-
$25.00 - Non-Residential
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Southold, New York 11971 O •`
Telephone 0( Jr_
Y►� •,
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
•
Fee $
DATE Lk i1 993
OWNER NAME: �E� e.
OWNER MAILING ADDRESS: (�o$ Loan CREeK �} Q�JE
c:jou I�.o LD kij j1911
OWNER -PROPERTY ADDRESS: (jO‘ 1-6636 CAALCG
mull tjPL
OWNER TELEPHONE NUMBER: 516) 1619.49301
TAX MAP NO. : Section 0 g 'a0 o Block ®3. 00 Lot 0 COO
CROSS STREET: ,L4tatit AAD MI) /'. u• Gfic4Jet.1
• TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New 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.)
- i a
Signature o f,,•licant
RECEIVED BY:
Town Clerk's Office
DATE:
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