HomeMy WebLinkAboutMichaels 0/10111,00•
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Town Hall, 53095 Main Road
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®'-i,' P.O. Box 1179
iQj `�%% el Southold, New York 11971
JUDITH T.TERRY <•�•�/� ''`� TELEPHONE(i6)7651801
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. 1511-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MICHAELS, LUCY E.
Mailing Address 1 P. O. BOX 484
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 3570 MINNEHAHA BLVD.
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5518
Tax Map No. section 87.00 block 3 lot 7.000
Cross Street OWAISSA STREET
Date Of Last Pump Out 0/00/00
Issue Date: 8/03/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• •
OFFICE OF THE TOWN CLERK -Irelbr
Town of Southold Q CQG_� Application No. A__57/
Judith T. Terry, Town Clerk rr, � �'� $10.00 - Residential
Town Hall, 53095 Main Roads -
P. O. Box 1179 cn 1:f y rt. ` *' T► ` • $25.00 - Non-Residential
Southold, New York 119710*��`
Telephone ( '�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE J U Ly 3 1® tq'o
OWNER NAME: LoY E. 1J c- Ae /s' • •
OWNER MAILING ADDRESS: Ao`x (743
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OWNER PROPERTY ADDRESS: 3.5-7 i 7)2//ir/ve �cZ/1� 1Lvd
-c'Cro7Wc � /(/' - e•-• 11577/
OWNER TELEPHONE NUMBER: 374 ® 7 5'.-- c575--/r.
TAX MAP NO. :- Section g 7 Block 3 Lot 7
CROSS STREET: (3 krp/..rsop 54eer
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool V New Existing
Residential / Non-Residential
DATE OF PUMP-OUT: U e /9q.0'
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.)
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(Ei AA.O. 41P-Z..")
Signature of Applicant ,
RECEIVED BY: -
'_ n Clerk's Office
DATE: AUG 03 100u
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