HomeMy WebLinkAboutNorman Town Hall, 53095 Main Road
LIM P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY ®� TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITALS rATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 851-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner NORMAN, JAMES J.
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Mailing Address 1 188 CARNATION AVENUE
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Mailing Address 2
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City St Zip FLORAL PARK NY 11001-0000
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Property Address 1 MILL LANE
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Property Address 2
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City St Zip PECONIC NY 11958-0000
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Owner Telephone No. 516-437-6654
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Tax Map No. section 67. 00 block 7 lot 5. 001
Cross Street MIAMI AVENUE
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Date Of Last Pump Out 0/00/00
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Issue Date: 9/21/88 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c�vFFO(,� �l
Town of Southold O�Q CSG Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road o -� Residential
P. 0. Box 1179 Ul 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 $ I® ;
DATE
OWNER NAME: ) s D7
o
OWNER MAILING ADDRESS: cvAv,
jTC wmlx - v d1-4l
OWNER PROPERTY ADDRESS: i iffl Lan'
Maw 6 /1211
L-L7
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section Block Lot S�
CROSS STREET: ��
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential 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.)
Signa pftof
pp icant
RECEIVED BY:
Town Clerk's Office
DATE: