HomeMy WebLinkAboutTaqggart i
Town Hall, 53095 Main Road
t. 8® p P.O. Box 1179
a �•�,i'� Southold, New York 11971
JUDITH T.TERRY ---...,,,,..6.-" 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. 1525-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner TAGGART, THOMAS A.
Mailing Address 1 P. O. BOX 249
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1025 HIAWATHA'S PATH
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1053
Tax Map No. section 78.00 block 3 lot 63.000
Cross Street NAKOMIS
Date Of Last Pump Out 0/00/00
Issue Date: 9/10/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
:.)`
OFFICE OF THE TOWN CLERK c3VFFO(,(-"
Town of Southold Q _� C��- Application No.f� j
Judith T. Terry, Town Clerk t 1 {t_.
Town Hall, 53095 Main Road $10.00 - Residential 4
P. O. Box 1179 u-3
u
, $25.00 - Non-Residential
Southold, New York 11971 O ® w 0�,���
Telephone Q( `J�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
-for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: //966-An7 / T� •
OWNER MAILING ADDRESS: ,O, Z K 29
u7Y6/.a 9 7/
OWNER PROPERTY ADDRESS:1007, /11dAT174,9-"S /,q7
z,7AA, /./97/
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 77 Block 3 Lot
CROSS STREET: /t nKD//S
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ► - Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: give&ir
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow a'nd feet
of distance, approximately, to building and closest road.)
Signature of Appli x
RECEIVED BY: 1,.(//
Town Clerk's ffice
DATE: ,jam (;)
•
'64-ts
...
_ .
.
, , 1.. , • . ,
,
. . ,
,
. .
, \ • ,
. •
.1
, 1
, -
, ' ,
, .. .
• , Me
, rl
- ,
% r
,
,
i \ , .., - ,
._
-
, \
,
(. ,
. t
•
-...._
--____ -.,,.....
---..,
"N._'\
•
-
,
-
-