HomeMy WebLinkAboutTaylor ODuri
Town Hall, 53095 Main Road
P.O. Box 1179
&v,� � Southold, New York 11971
JUDITH T.TERRY ®4.C ' TELEPHONE
TOWN CLERK %.,, (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. 842-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner TAYLOR, BELLE
Mailing Address 1 C/O HAROLD TAYLOR
Mailing Address 2 21 LINDEN STREET
City St Zip HUNTINGTON NY 11743-0000
Property Address 1 MIDDLE ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-673-8970
Tax Map No. section 96.00 block 1 lot 4. 000
Cross Street DEPOT LANE
Date Of Last Pump Out 0/00/00
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Issue Date: 9/16/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK q�-\FWU(
Town of Southold Q es Application No. (PSIS
Judith T. Terry, Town Clerk �� ;f';i �
Town Hall 53095 Main Road
" � Residential
, � k .A�2 Z4�e2y/Zv: -
P. O. Box 1179 # `� r mo Non-Residential
Southold, New York 11971r
Telephone Q( `jib '0
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
•
DATE / f �
ll OWNER NAME:____ �_, ,� e / 4_, 0, P
OWNER MAILING ADDn1 ) 1 �--' I L � p 744_
OWNER PROPERTY ADDRESS{ Y)')��
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section ( Block / Lot 5/
CROSS STREET: t) e /Do / /9 A-1
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
p 9
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.)
,,, 1 I f
T gnatu a of • pplicant
RECEIVED BY:
Town Clerk's Office
RECc IVFly
DATE:
SEP 1 6 lb•
town Clerk Southold
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