HomeMy WebLinkAboutOates of
5 5 Town Hall, 53095 Main Road
® �.'� P.O. Box 1179
NN,„,, FAX•• Southold, New York 11971
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JUDITH T.TERRY �� ''� (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. 1531-R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
New Existing X
Name Of Owner OATES, JOSEPH P.
Mailing Address T 3900 PINE NECK ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 3900 PINE NECK ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-865-3219
Tax Map No. section 70.00 block 12 lot 18.000
Cross Street OAKWOOD DRIVE
Date Of Last Pump Out 0/00/80
Issue Date: 9/25/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK o F ,
Town of Southold (4.1. Application No. /52/
Judith T. Terry, Town Clerk . p.. )-.;-,;7",e A791
Town Hall, 53095 Main Road ?c :'� 1 $10.00 - Residential V
e yy
p. O. Box, 1179 to °mak K ; $25.00 - Non-Residential
Southold, New York 11971 Obi '�_s01�$
Telephone Oj * ��
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER- DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL.
Operation Permit No.
Fee $ /D. o°
• DATEAd gi i 9a -
'OWNER NAME: d •
OWNER MAILING ADDRESS:3 Q c O .
nz7,64the / -2z "7,4'
- , OWNER PROPERTY ADDRESS: �✓ � � G /C�•
pp_a. / / 9 7
OWNER TELEPHONE NUMBER: _37 - 74,
TAX MAP NO. : Section ---7O Block /\a, Lot J"
CROSS STREET: (P!/14Dl er A �a • (9/4 H ,
TYPE OF SYSTEM: Septic Tank New Existing-
Ilittaioirot Cesspool New4O 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.)
7 v.
natu/e -of Applicant
RECEIVED .. •�;i
"Town Clerk's Office -
4aMT-E: SEP " 1990
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Pr6-617 i!/
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