HomeMy WebLinkAboutMerdo .5 x
10111.,
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Town Hall, 53095 Main Road
P.O. Box 1179
`� a l. Southold, New York 11971
JUDITH T.TERRY 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. 915-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner MERDO, ANDREW
Mailing Address 1 P. 0 . BOX 116
Mailing Address 2
City St Zip CUTCHOGUE , NY 11935-0000
Property Address 1 26760 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No . 516-734-5242
Tax Map No. section 109 . 00 block 5 lot 2 . 000
Cross Street HIGHLAND ROAD
Date Of Last Pump Out 9/00/84
Issue Date: 11 /09/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
..
OFFICE OF THE TOWN CLERK I•�FF� i
Town of Southold ;, Application No. / -6.-
Judith T. Terry, Town Clerk
Town Hall, 53095 Main RoadF F L Residential
P. O. Box 1179 tri =x: t.41 A ; `' Non-Residential
Southold, New York 11971 O` 0���`
Telephone �(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
•
Fee $ /d., /)/)
DATE /1— D 7— 8' R'
- OWNER NAME: `lavish' k/ /V/\.A P
OWNER MAILING ADDRESS: /0, OX /I MAIN RnA/
LA c H o -6:1(5. N Ab,y,, / / 93OWNER PROPERTY ADDRESS: °dce '7 5 - Q
OWNER TELEPHONE NUMBER: 5-gG-- 734(—J��
s _
TAX MAP NO. : Section /D ? Block �5Lot
CROSS STREET: // / Al LANA R h _
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.)
DA•ek0_,i2.2)
Signature of Applicant
•
RECEIVED BY:
Town Clerk's Office "
DATE:
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