HomeMy WebLinkAboutMinton ,� �••iIS/ i.,.'+I
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Town Hall, 53095 Main Road
,y® sr s' P.O. Box 1179
___ ®1 .��e' Southold, New York 11971
JUDITH T.TERRY
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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. 657-R Residential X Non-Residential
Fee $ 100. 00 Septic Cesspool X
New Existing X
Name Of Owner MINTON, CHARLES L. AND MARY
Mailing Address 1 P.O. BOX 778
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 5190 PECONIC BAY BLVD
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-9444
Tax Map No. section 128. 00 block 2 lot 20. 000
Cross Street BIRCH DRIVE
Date Of Last Pump Out 0/00/00
Issue Date: 3/25/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• Alt
OFFICE OF THE TOWN CLERK7
Town of Southold O '`Q Application No.6 S
�
Judith T. Terry, Town Clerk � .. L :4=
� Residential
Town Hall, 53095 Main Road u
ccs �-_ FZj t
P. O. Box 1179 "� � �r 1� ` Non-Residential
Southold, New York 11971 O ® .a _, •��`
Telephone ®j �i
(516) .765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ (0
DATE
OWNER NAME: //%AL /� J • /7 / N/4/701-4-/
OWNER MAILING ADDRESS: / r.e2- ,ge 72p
OWNER PROPERTY ADDRESS: ,s/GJ,y /3,42f /9//ic/
OWNER TELEPHONE NUMBER: 9 �G 'V
TAX MAP NO. : Section / a- Block Lot o2) •
CROSS STREET: /g/f/.(74:(
TYPE-OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /e!i/'/
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.)
Signature of Applicant
RECEIVED BY: i� a
Tow CIeX k's Offic
DATE: ( VCA 6— Ui
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