HomeMy WebLinkAboutTaylor (2) ry Town Hall, 53095 Main Road
��'� P.O. Box 1179
��
Southold
_��� v; ���. , New York 11971
JUDITH T.TERRY `-1s ,i-f' TELEPHONE
TOWN CLERK pr (516)765-1801
REGISTRAR OP VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 841-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner TAYLOR, BELLE & ANOTHER
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 (COUNTY RT 48)
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-673-8970
Tax Map No. section 96. 00 block 2 lot 6. 000
Cross Street DEPOT LANE
Date Of Last Pump Out 0/00/00
Issue Date: 9/16/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL) ,
•
OFFICE OF THE TOWN CLERK c,3�FFO(,r
Town of Southold C' - F-�1
, 0_ Q Application No.
Judith T. Terry, Town Clerk �� �,:"� „j ` G
Town Hall, 53095 Main Road a •-"-'9' -4 .G Residential c/
P. O. Box 1179 i , w �z Non-Residential
Southold, New York 11971 Q,%� 0. -,,,,,;,1 `'/
Telephone *iZj s •
Ii.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
.for- •
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 79 ', •
DATE CI / / c:D / r7 '
,
• OWNER NAME: r " -_ _, , s � 11)A/C
OWNER MAILING ADDRESS: / / - C'4 E '/ %
C 1 / / / / r, i\-1OWNER PROPERTY ADDRESS: - " J2 (:? _, 7
' (_} / Ck? n C--- .(-) e___}
,A,...__21
OWNER TELEPHONE NUMBER /c G7�- g..9 7 I
:
., "
TAX MAP NO. : Section c:, Block c:2- Lot
Ct -") ,
CROSS STREET: P �p l i\s,/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool - . i------..-------
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.)
...______ /
ignature o' ; •plicant / -
RECEIVED BY:
REcr kSown Clerk's Office
DATE: sEp 1 / f23
Town Clerk Southold -
C)'LC ee-7
(
1A3 et °II
Mg A 1 •
II