HomeMy WebLinkAboutNoble JUDITH T. TERRY ' ' ' i_ ; � Town Hall, 53095 Main Road
TOWN CLERK �•r!a �• S P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ,. �,� lJ Southold, New York 11971
MARRIAGE OFFICER tet fy �A,• . alLY Fax (516) 765-1823
..., ; ', 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. 1599-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner NOBLE, DOUGLAS M.
Mailing Address 1 P. O. BOX 198
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 35 MADISON STREET
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-2613
Tax Map No. section 40.00 block 5 lot 23.000
Cross Street WILMARTH AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 1/17/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
► \,0r"
OFFICE OF THE TOWN CLERK •S\\FFeUr y
Town of Southold CQG� Application No. /5
Judith T. Terry, Town Clerk . .•47.t
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 (
� ®� $25.00 - Non-Residential
Southold, New York 11971 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 / � d / 9d
'OWNER NAME: AJOt14:L/9 N)&&E • •
•
OWNER MAILING ADDRESS: P.0 6o> 19
ee6-we er , J!!' / /94
OWNER PROPERTY ADDRESS: j pligb)5 ,J S-Ide&677
4 RL=62tf e aer
OWNER TELEPHONE NUMBER: 407 - e; l 3
TAX MAP NO. : Section 4.. o Block 5 Lot 2 3
CROSS STREET: 14.J L msg-ri -741 k"
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: F ) j,P,°l '/c�'c
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.)
4
Sig ature of Ap1511cant
RECEIVED BY:
Town Clerk's Office
DATE:
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