HomeMy WebLinkAboutNorris Town Hall, 53095 Main Road-
P.O. Box 1179
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. 1365-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner NORRIS, WENDY
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Mailing Address 1 P. O. BOX 25
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Mailing Address 2
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City St Zip MATTITUCK NY 11952-0000
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Property Address 1 NEW SUFFOLK AVENUE
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Property Address 2
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City St Zip MATTITUCK NY 11952-0000
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Owner Telephone No. 516-298-8349
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Tax Map No. section 115.00 block 9 lot 4.000
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Cross Street REEVE AVENUE
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Date Of Last Pump Out 0/00/00
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Issue Date: 1/11/90 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK '���FO(,� /
Town of Southold "" �� C'�G Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential X
p. 0. Box 1179 cry $25.00 - Non-Residential
Southold, New York 11971 O
TelephoneOj
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ _10,0-0
DATElgq
OWNER NAME: WEAlbV NV022TS
OWNER MAILING ADDRESS: -0-80X a5
�ATTz�ci:, Ny li�s� -
OWNER PROPERTY ADDRESS: /VeW 3bLFFL1,_1
/1'1 ATTz7uc�, by i r9.S,�.
OWNER TELEPHONE NUMBER:
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TAX MAP NO. : Section Block Lot
.CROSS STREET: 2EE✓F- hmctF
TYPE OF SYSTEM: Septic Tank New Existing /
Cesspool New Existing V
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: GL 1;:WOW j
LOCATION MAP: Must be attached hereto before permit may be issued.
S (Locate building and system; give north arrow and feet
LU of distance, approximately, to building and closest road.)
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e _
Signature of Applicant
J•
RECEIVED BY:
Town Clerk's Office
DATE: