HomeMy WebLinkAboutMillman .014if Wire
Town Hall, 53095 Main Road
g ,r ��
�` P.O. Box 1179
�01� Southold, New York 11971
JUDITH T.TERRY = ®� i TELEPHONE
TOWN CLERK �/ (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. 921-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MILLMAN, SAUL
Mailing Address 1 31605 NORTH ROAD
Mailing Address 2
City St Zip PECON I CD NY 11958-0000
Property Address 1 31605 NORTH ROAD
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-734-5092
Tax Map No. section 74.00 block 1 lot 23.000
Cross Street HENRY'S LANE
Date Of Last Pump Out 0/00/00
Issue Date: 11/17/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
Ie
OFFICE OF THE TOWN CLERK 5��F0(,';Q
Town of Southold �� ' Application No. 9.-3.72/
Judith T. Terry, Town Clerk ,. -
Town Hall, 53095 Main Road �' - ` Residential
P. O. Box 1179 v' ri ; Non-Residential
Southold, New York 11971 O - �
o
�
Telephone ,(
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE // - / /'— pp'
OWNER NAME: A ,/ p--", ti -,4,j
OWNER MAILING ADDRESS: 3/4o,S— /J -t--it ji
#0,-77,
OWNER PROPERTY ADDRESS: S341
OWNER TELEPHONE NUMBER: 7.3o J ?J92_
TAX MAP NO. : Section 1 `T Block / Lot
CROSS STREET: (
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 1// New Existing �r
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.)
•
Signat ire of Applicant
N O V 1 71988
RECEIVED B Y: � ,. a ,Roa,1i
°"--Town Clerk's Office
DATE: G jcq/a
j ,
i
G
0
1 o
! L____Ij
d