HomeMy WebLinkAboutMilne JUDITH T. TERRY `t Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS • Southold, New York 11971
MARRIAGE OFFICER ®� Fax Fax (516) 765-1823
,y®4 �� ��� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2022-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
✓
New isting
Name Of Owner MILNE, KAT
Mailing Address 1 P. O. BOX 1707
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 3875 WICKHAM AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9543
Tax Map No. section 107.00 block 9 lot 4.000
Cross Street MARY'S ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 12/16/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
O FICE�OF THE TOWN CLERK CSFULA' °
T
own of Southold �� .X, CQG' , Application No. aG oZ,,,
Judith T. Terry, Town Clerk % , y
Town Hall, 53095 Main Road ' ~ tk.t. 4•. $10.00 - Residential
P. O. Box 1179 cry �- ��`' $25.00 - 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 tQli9q"1
OWNER NAME: Kl,l IiLI e'e-(/I1.4-lime
OWNER MAILING ADDRESS: p,0 , ' U d t` 110/7
. ketbNitd(f my toil- , -
OWNER PROPERTY ADDRESS: 3 g7 l/t/ ic1:11("A f -
- c( )jy ,/qsZ -
OWNER TELEPHONE NUMBER: Si(0 g- ' t3
TAX MAP NO. : Section [07, 06 Block 1 Lot 4, de(7
CROSS STREET: kiqg k.ollb
TYPE OF SYSTEM: Septic Tank - - New Existing
Cesspool ( New Existing
Residential 3 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.)
. oodd44 Mi-c,
Signature of Applicant
•
RECEIVED BY: . �/��� "
Town Clerk's Office
DATE:- l.1-1t /
•
L 4. ,
-;CD-
! . -- 7 -' -
iJI° o
op,
r