HomeMy WebLinkAboutMiller (2) c ) tr-vi Town Hall, 53095 Main Road
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P.O. Box 1179
.V4® , r!.4 Southold, New York 11971
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JUDITH T.TERRY
N.:- 11'`r� FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-65-
1801
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. 1392-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MILLER, FRANK J.
Mailing Address 1 MAIN ROAD
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-3601
Tax Map No. section 18.00 block 6 lot 11 .000
Cross Street PLATT ROAD
Date Of Last Pump Out 9/00/85
Issue Date: 2/22/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
\' ,OF THE TOWN CLERK.
F •
C
own of Southold Q r« C� Application No. /a/ -
Juditl.?'T. Terry, Town Clerk
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Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 u-3 .="4 . $25.00 - Non-Residential
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Southold, New York 11971 ��`�
Telephone Art..
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ t° J 00
DATE
✓�� / / 'd
OWNER NAME: /./?/40( J. ty),_.
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: S.44td
OWNER TELEPHONE NUMBER: 3.23 ` 363 (
TAX MAP NO. : Section a Block 6 Lot f /
CROSS STREET: /2.. RAJ
TYPE OF SYSTEM: Septic Tank - New Existing C'
Cesspool New Existing
Residential 7 NQn-Resider�ti
DATE OF PREVIOUS PUMP-OUT: 11/1-veivia-F /”"°
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.)
QL,eit..._ i
S gna re of • pplicant
RECEIVED BY:
• Town Clerk's Office
14116,N
DATE: RECEIVED 1"' !•
FEB 2 -
Town Clerk Southold
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MAP OF LAN® .
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FR..AN K J. MILLER.
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