HomeMy WebLinkAboutMilius ��11°I\VI f f
Town Hall, 53095 Main Road
c� W P.O. Box 1179
-----.741
' ���'' Southold, New York 11971
JUDITH T.TERRY -_ ._1 /rl�''' TELEPHONE
TOWN CLERK ! (516) 765-1801
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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. 940-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MILIUS, LAWRENCE
Mailing Address 1 BOX 187
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 830 NEW SUFFOLK ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5857
Tax Map No. section 109.00 block 6 lot 7.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 12/05/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ��U�FO
Town of Southold �Q5 42 , Application No. 4 4)
Judith T. Terry; Town Clerk �����, r't:"
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Town Hall, 53095 Main Road c °^ : Residential
P. 0. Box 1179 v' = .7,R:'1;04 + i'` Non-Residential
Southold, New York- 11,971 O'er® `�J
Telephone 0.(
(516) 765-1801
TOWN- OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 9�d
Fee $ IDA 0
•
DATE I 9t 20,7"
OWNER NAME: L-GwrenQe. \ tLLS
OWNER MAILING ADDRESS: --at,�C
Q-L01-61N t LSI 8
I
OWNER PROPERTY ADDRESS:-_g 3-0 S u. �-o ( ' • -
CJ -c n lLia Lg C
OWNER TELEPHONE NUMBER: S Co 1 3
TAX MAP NO. : Section /0 9 Block 4 Lot
7
CROSS STREET: a.. ,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential ,,>Z Non-Residential
DATE OF PREVIOUS PUMP-OUT: c)1 %-g
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.)
—�� ig at. e of Applicant •
RECEIVE D.. o- _ ,ALL
Town Cler ' s Office
DATE: DEC 0 5 198aeg
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