HomeMy WebLinkAboutMiller (2) \Of Wire"
Town Hall, 53095 Main Road
t®, 1Y P.O. Box 1179
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� .i! Southold, New York 11971
JUDITH T.TERRY �, / i����l FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
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. 1208-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MILLER, JOSEPH AND CAROL
Mailing Address 1 220 WEST SHORE DRIVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 220 WEST SHORE DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2841
Tax Map No. section 80.00 block 3 lot 4.000
Cross Street OAK DRIVE
Date Of Last Pump Out '0/00/00
Issue Date: 8/07/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
se
OFFICE OF THE TOWN CLERK SWITU(
Town of Southold _ C� ' Application No. 4.We
Judith T. Terry, Town Clerk Z o 7
7N ft, '� $10.00 - Residential G✓
Town Hall, 53095 Main Road '
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P. O. Box 1179 $25.00 - Non-Residential
Southold, New York 11971
Telephone ol II
S
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
$ //6Fee
DATE r3 ' If
OWNER NAME: S p -I- CAIZ 01, y L Lf r •
•
OWNER MAILING ADDRESS: .2-2- 3 u' �- 9'T S ,6 V(
u o lAk a LO �� . 071 -
OWNER PROPERTY ADDRESS: - --
OWNER TELEPHONE NUMBER: 7(, �� c2tf'/
TAX MAP NO. : Section tO Block 3 Lot ,C)
CROSS STREET: 3)R f l/
TYPE OF SYSTEM: Septic Tank t-'"• New Existing
Cesspo �Tew Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: dc/ >‘' /WP
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.)
410
,41Ir
S> nature of Applicant
RECEIVED BY: t*
Town Clerk's Office
AUG U 'A
DATE:
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