HomeMy WebLinkAboutMercier ;per
t- 7' .a Town Hall, 53095 Main Road
� � � ��`� P.O. Box 1179
---_7410/ :µ �p�.0� Southold, New York 11971
JUDITH T.TERRY ` �� /x.00 TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF,TIE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT '
SEPTIC TANK or CESSPOOL
Operation Permit No. 670-R Residential X Non-Residential
Fee $ 10. 00 Septic X Cesspool
New Existing X
Name Of Owner MERCIER, THOMAS AND BARBARA
Mailing Address 1 P.O. BOX 1423
City St Zip MATTITUCK NY 11952-0000
Property Address 1 700 NEW SUFFOLK AVENUE
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8487
Tax Map No. section 114. 00 block 12 lot 6.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 4/19/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
"4, y
OFFICE OF THE TOWN CLERK C3UFFD(,?
Town of Southold �� _ x.. QG Application No. G 7v
Judith T. Terry, Town Clerk • fa` �'
'" `
Town Hall, I. 1 Residential
53095 Main Road � �� z � �;-
P. O. Box 1179v.-VA Non-Residential
Southold, New York 11971
Telephone _
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE ti:-.13-88'
OWNER NAME: 1---1(1-0N6 MG'‹
OWNER MAILING ADDRESS: ��,6DJC /11123
rn ATT e` 7 � P9
OWNER PROPERTY ADDRESS: W6 AI6 't) e ,,VE-
7/1
OWNER TELEPHONE NUMBER: ,--tre7
TAX MAP NO. : Section MI- Block / 2— Lot 6
CROSS STREET: 4 /I) s
TYPE OF SYSTEM: Septic Tank - New xisting
Cesspool New Existing
esidentia Non-Residential
DATE OF PREVIOUS PUMP-OUT: ,AVingeAd- kit
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.)
7)/441La- --L-
Signature of Applicant
RECEIVED BY:Z �, F
REC V ow Clerkig Office
DATE: APR 1 9 16::
Town Clerk Southold
,A) o/0 S)74 7'Tdam u'
MATO rLek
fa-TrC iCt55?/?2_,
(6 616 A) A40
J'f4
yr:T\ lot
7,7
Arm
1
\\/ 7
QUA (14 17>P1 _ 4
nr �
kiv
r
s