HomeMy WebLinkAboutMelrose C)
%1 �®
JUDITH T. TERRY Town Hall, 53095 Main Road•
TOWN CLERK ,, P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
00," Fax (516) 765-1823
MARRIAGE OFFICER V r
�,�/®1 '� 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. 3005-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MELROSE, JAMES I .
Mailing Address 1 600 ROBINSON ROAD -
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 600 ROBINSON ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0511.2
Tax Map No. section 34.00 block 5 lot 16.000
Cross Street CHAMPLIN PLACE
Date Of Last Pump Out 0/00/00
fr 610102=54,6
ea.44446 -
Issue Date: 4/27/93 Judith T. Terr
Southold Town Clerk
(TOWN SEAL)
D "
. ' • •i.
OFFICE OF THE TOWN CLERK c�vVFQCR?,=
Town of Southold Q CQ Application No. c3005----
Judith
fa65"'Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road .;••• -< - $10.00 - Residential
P. O. Box 1179 u' �' �� ' ;'. ti $25.00 - Non-Residential
Southold, New York 11971 O ` -
Telephone
516 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ (.2)0
DATE l \A"1--
.-r, ` 1
OWNER NAME:
OWNER MAILING ADDRESS: CD Q®
--OWNER OWNER PROPERTY ADDRESS: _ - - - - - - -
OWNER TELEPHONE `NUMBER:
TAX MAP NO. : Section Block Lot t
CROSS STREET:
TYPE;OF`SYS,TEM: Septic Tank -"\ ' New '. Existing
Cesspool a, New •. Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: \°\e5,1„
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.)
Sign• ure of App 'cant L
\m ...)RECEIVED- BY: ___ __ __._-- —
..
Town Clerk's Office
DATE'.
. b si r\o__%n 4
s4 , ..
..
, \ \
6,,O , , ` ,,; `
P 1k „,
\
, ":., \ ,(-2,,0 '‘j- ''-,,,, ,
- A ''- i
Cif' .. ,-„, Ni.v
,i3::\\::\:::,
1 0
\i
r....\ ,...i.soofArz
Pd...., � \., .` ... ,
, ', ., ,
„ ,,
, .
.,
l V - ,