HomeMy WebLinkAboutNichols /,I CFF I ®
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°�' Town Hall, 53095 Main Road
V° P.O. Box 1179
®0 it ®��� Southold, New York 11971
JUDITH T.TERRY %dMiall/Io�� 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. 683-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner NICHOLS, ARTHUR E.
Mailing Address 1 NICHOLS, ANDREA
1 MIDDLETON ROAD
City St Zip GREENPORT NY 11944-0000
Property Address 1
1 MIDDLETON ROAD
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0349
Tax Map No. section 33 . 00 block 5 lot 16.000
Cross Street COUNTY RT 48
Date Of Last Pump Out 0/00/00
Issue Date: 4/28/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
BEd ..7
OFFICE OF THE TOWN CLERK ^OFQ(rrg•-9Town of Southold �v �Q� Application No.
Judith T. Terry, Town Clerk `° :`; � qk
Town Hall, 53095 Main Road Residential
p. O. Box 1179 Non-Residential
Southold, New York 11971 �.®�,•��•.
Telephone ®.( 441 NX°
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
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OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ ( ): pCJ
DATE (//.2/�
OWNER NAME: j\ 1R-T-14 v I E . / CN oZ /J f 4 jt),c1-43LS
OWNER MAILING ADDRESS: I ✓2/ /1]DLL. e,J
e g a E. )Po 2i ~ccJ Yo/2<
OWNER PROPERTY ADDRESS: Co CouM V ko1gb (1.8-
(-/ DL-. 715A-)
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(-/L L "n AJ 7Zoy-b (EE-X-P6 T
OWNER TELEPHONE NUMBER: (L57 03z/9
TAX MAP NO. : Section 33 Block Lot 7C
CROSS STREET: flit/ -j) tE?c IJ 7?-6)4I-b
TYPE OF SYSTEM: Septic Tank New Existing r/
Cesspool New Existing ,/
Residential V 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.)
Signature of Applicant
RECEIVED BY:
ownerkREa '412
's ffice
DATE: Aril 2 8 1088
Town Cleric Southold
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