HomeMy WebLinkAboutTenedios JUDITH T. TERRY 4 .. Town Hall, 53095 Main Road
TOWN CLERK • Southold, New York 11971
r,, " P 0. Box 1179
REGISTRAR OF VITAL STATISTICS ��
MARRIAGE OFFICER ® ; Fax (516) 765-1823
�® 4-1 0.04./
6.1 Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1746-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner TENEDIOS, STEVE
Mailing Address 1 P. O. BOX 44
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 940 HENRYS LANE
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-765-3430
Tax Map No. section 74.00 block 2 lot 29.000
Cross Street NORTH ROAD •
Date Of Last Pump Out 7/00/78
s
Issue Date: 9/04/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I
OFFICE OF-THE TOWN CLERK cvFFOLA/ -
�Town of Southold �� CQ ' Application No. /74/6
wiu ith T. Terry, Town Clerk
Town Hall, 53095 Main Road . :'�
o $10.00 - Residential
P. O. Box 1179 ff* "-is '` � $25.00 - Non-Residential
�rtt
Southold, New York 11971 *0-4-101
. �`
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 44- 9/9/
OWNER" NAME:
OWNER MAILING ADDRESS: 10- 0• Pox %4. - pECDiv/ 6 /V-Y. //9 Y
OWNER PROPERTY ADDRESS: 1440 /4/i1/gys h /tPECe,w _
OWNER TELEPHONE NUMBER: 744 -- 3 44.3 CJ
TAX MAP NO. : Section 79 Block 2. Lot ' 9
CROSS STREET: e--60d�
TYPE OF SYSTEM: Septic Tank // New Existing
Cesspool /,/ New Existing f�
Residential j," Non-Residential
DATE OF PREVIOUS PUMP-OUT: JUL,. /510
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.)
Signature of Applicant
RECEIVED BY:
Town CI k's Offirce
DATE: INEq�����p�
AVrt.
§EP 041991
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