HomeMy WebLinkAboutMoris 4.40001
Town Hall, 53095 Main Road
P.O. Box 1179
®1 ��®��� Southold, New York 11971
JUDITH T. TERRY ����i� 000/ 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. 1108-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner MORRIS, DAYSMAN
Mailing Address 1 2760 YENNECOTT DRIVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 LINNET STREET
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-765-3300
Tax Map No. section 48.00 block 3 lot 6.000
Cross Street NINTH STREET
Date Of Last Pump Out 0/00/00
Issue Date: 5/12/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
t
OFFICE OF THE TOWN CLERK �c��FF U( --
Town of Southold �, ro> CQ ' Application No. /7 o '
Judith T. Terry, Town Clerk % A.,... m `'� Vi`µ G
Town Hall, 53,095 Main Road - ,.
g:' ` 4 :t Residential
P. O. Box 1179 cn `x. " i ' ' %. Non-Residential
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Southold, New York 11971 O t:_a ��
Telephone *el Adit ygal '.
MI f
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /U U�- .
DATE Way g• 17
OWNER NAME: /
OWNER MAILING ADD SS: 2 760 A/ .
12 .1.;;" " .
/
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 7t3 3 Roo
y TAX MAP NO. : Section [./O Block 3 Lot
CROSS STREET: 9
4 ._ 1-- --
TYPE OF SYSTEM: Septic Tank Existing .e.--------
Cesspool v New Existing
Residential I 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.)
IF
gnature of Applicant
RECEIVED BY: ) , (A),(14.--,______, '
Town
Clerk's Office
DATE: C/z/ (r7
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