HomeMy WebLinkAboutMoisa (3) 40- air
Town Hall, 53095 Main Road,
t V O P.O. Box 1179
,Q®e ci\w‘ 1, Southold, New York 11971
JUDITH T.TERRY 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. 1351-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MOISA, STANLEY
Mailing Address 1 46 SUNSET LANE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 46 SUNSET LANE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1331
Tax Map No. section 33.00 block 4 lot 63.000
Cross Street SOUND DRIVE
Date Of Last Pump Out 11/01/85
Issue Date: 12/21/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK .c0FDU(�"•
Town of Southold CApplication No. / -6--/
Judith
Judith T. Terry, Town Clerk .E A � y
Town Hall, 53095 Main Road � i $10.00 - Residential
2. x YL e r`s��,::
P. 0. Box 1179 to •ha h�i . $25.00 — Non-Residential
Southold, New York 11971 `",>'
TelephoneQ(- `), of
124 f
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE /20<r, 1. // / ,'j
OWNER NAME: 77� • •
OWNER MAILING ADDRESS: y/ 6
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: V7 7— J 3 .3
TAX MAP NO. : Section 3 3 Block Lot 6 3
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing ,A/
Residential k Non-Residential
DATE OF PREVIOUS PUMP-OUT: 24-465.Z.) 1 / 7 6`
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: /1 -��
Town Clerk's Office
DATE: / /— '
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