HomeMy WebLinkAboutTerp Town Hall, 53095 Main Road
rW �r
- ®" P.O. Box 1179
®olo Southold, New York 11971
JUDITH T.TERRY FAX(516)765-1823
TOWN CLERK TELEPHONE(516)7654801
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. 1214-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner TERP, JOHN
Mailing Address 1 P. O. BOX 297
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 750 MAPLE LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3624
Tax Map No. section 64.00 block 1 lot 22.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 8/25/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I ii.o •
OFFICE OF THE TOWN CLERK S\\FFO(,�,'-
Town of Southold Q ' Application No. 12-i 4
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road '44. -, ; r $10.00 Residential
P. O. Box 1179 in ,-,
t-',•,�:'� �,.. r �% $25.00 - Non-Residential
Southold, New York 11971 "®t^ � 1,
Telephone Q( e `A�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
. DATE r/6/ /il
OWNER NAME: ,) On \y---- �• �
OWNER MAILING ADDRESS: 5AE 1r-ck T4P-- P o, BO,kc27C/
sour>c , \) NI . 1 \ 9 I
OWNER PROPERTY ADDRESS: —ISO a pLe.„ A'�A�
OWNER TELEPHONE NUMBER: 74,55-- \ (oat-,r
> TAX MAP NO. : Section Co C`I Block ( Lot
CROSS STREET: Vim'eLt: 1 OE _
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool 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.)
/Z/ Signature of A re
RECEIVED BY: (1-A4-A----.`
9
Town Clerk's Office
DATE: b q 1 i
,
,----------- -Y' '''-cj''''/-(
k
Gj , � �/
1X 4# �------4__. . --'
-�� 1
I`\I '\
,