HomeMy WebLinkAboutTese re�K�QG
JUDITH T. TERRYTown Hall, 53095 Main Road
TOWN CLERK Z T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS (Ss Southold, New York 11971
MARRIAGE OFFICER •, Fax (516) 765-1823
�,�01 �1D ,o' 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. 3014-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner TESE, MARJORIE E.
Mailing Address 1 P. O. BOX 3
Mailing Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Property Address 1 1245 JACKSON STREET
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-734-5369
Tax Map No. section 117.00 block 9 lot 10.000
Cross Street FIFTH STREET
Date Of Last Pump Out 0/00/00
Issue Date: 4/30/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c,VVFO(ir
Town of Southold Application No.
gs-AO:Judith T. Terry, Town Clerk :_ �►
Town Hall, 53095 Main Road a � - $10.00 - Residential
p. O. Box 1179 u' r• ' z $25.00 - Non-Residential
Southold, New York 11971 ." �►
Telephone ( ��
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 31 / 7 /T5
OWNER NAME: flA (2 li .i 1e5`c`
OWNER MAILING ADDRESS: ) ).,,14-5' ,<< .E
po 11,2,
4 /AV,
----OWNER PROPERTY ADDRESS-:-1- 4.5" -1'
t.tG t/M... ) ' f'�f- fir'
OWNER TELEPHONE NUMBER: cd ,^73L71�,5*,7
. TAX MAP NO. : Section ( 1"--7, Block Lot -/O
CROSS STREET: /.Q( Jce r
TYPE OF,-SYSTEM: Septic Tank =- -- New Existing
Cesspool New Existing
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUL.'Vi. 't
-V 1`L- U, ,� .1
LOCATION MAP: Must be attached hereto before permit may be i sued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
RECEIVED
APR 3 0 1993 1114/T4-/-4:c-- fr? -
Southold Town Clerk Signature of Applicant
•
RECEIVE D BY:
Town ler ffice
DATE: ! r 30 q3
.'LAP V(j
i ---":—,1.).13.',.(i.------Y+
.._Ll {J1Z_
iii���', 1! J2JCi2Ei
t 0., 4'7$_8V2 _ J"7fiv I. is ',l-1 t'F-:Ji: . .
tfl i GA-12.1 17 in
-i _���,.� -RPA.2¢ 999 a (I) — — --
}llC' i<1.
- -!F.•.✓ Fir-:. li L ' `�.�'_74.1 :J •-.`�' .:�..
C...) :l}, I r !: ' h-i' lr:e?O1 s inked reel O'dc
= LL ;�S + ii
u a ;` `-, 2 1z:i+d true copy.
Id
` T A = - 2 9..T..7.'is l' ! IQ LI' Cii: it<_bs Indiczted hereon s5-t1 r'-?
=+ } --t FTS 1--,'-'•_ 1 +' 11I. '1. cn+;+r-1,:e•pr,rson for wh:•:fr.,f.F;,_,"
,+ i '1 i llf ! . .._�«3,end an his bet-_-.!::o:'D
y,j e.
i' i;� k -,.-µY,cK-e enTrcn•r
• .•rl f, t _ „:::.,t::"-:. ..iAaOns O'S:1:: __ ,a
Mn, L. r`+ 1. r:`'1i� I� -i,A11_lh:C.:;Ei_�V-.rzEE r 1
y e• !• ..t.. `.1 _:, e� 1'1F1.1 4 }
c. - l
JA r
--1
\ ,
•
F ! Y F t/ — ---.._ - - jti'\J` `� r v� {f P " �G�: VA Jay:i
i.
t.
t 1'_ , ./-- �I . V +:/.k a - 1.. . r•.'_ - �! r° :. ."i.� �'kl < # �t _ file-� f et'.t_i _tL -- J--'• - `!-'E.
ltfl7ii'4 r§ t— t
-t—' S 2 \
°