HomeMy WebLinkAboutTerry (2) faii AM!
; .. ,�� Town Hall, 53095 Main Road
r P.O. Box 1179
+ ®�d Southold, New York 11971
JUDITH T.TERRY
\4.442
�� . „ � � 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. 1199-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner TERRY, LLOYD E.
Mailing Address 1 MAIN ROAD
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2568
Tax Map No. section 20.00 block 1 lot 1 .003
Cross Street TERRY LANE
Date Of Last Pump Out 0/00/00
Issue Date: 8/01/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• .I. .
OFFICE OF THE TOWN CLERK ������ ''-
Town of Southold �� C0 Application No. /197
Judith T. Terry, Town Clerk *1
Town Hall, 53095 Main Road Ys� r :`"'"`,^rte;= : l $10.00 - Residential ,�
P. O. Box 1179 .I , ,, i $25.00 - Non-Residential
Southold, New York 11971 O '®_�= °'�O��J
Telephone Ol [ `'t
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. // c/'
Fee $ /()
• DATEP\I i g` — 7
OWNER NAME:
Ce 7-C-72Zir),( .
• IF
OWNER MAILIN ADD' SS:� 7 ' 1
,c, jVI //M-7— 9. 7 /n '
OWNER PROPERTY ADDRESS: (V),_--�44K
OWNER TELEPHONE NUMBER: N/,6 `�� , -®�J C
TAX MAP NO. : Section ,,-1-'l, 3 Block Lot
CROSS STREET: /7776/21g ,�_ _
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing t____
Residential (,------ Non-Residential
DATE OF PREVIOUS PUMP-OUT: t W " ( 727
LOCATION MAP: Must be attached her o before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
Si,R &A in-----
L-4-y
(1 afture of App lica
RECEIVED BY: aczc (-,,-, &
Town Clerk's 'Office
DATE: MV
AUG Uj 1989
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