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HomeMy WebLinkAboutTurner 11 ® Town Hall, 53095 Main Road JUDITH T. TERRY y TOWN CLERK ; p . % P.O. BOX 1179 REGISTRAR OF VITAL STATISTICS X W .% Southold, New York 11971 MARRIAGE OFFICER (2) 40' Fax (516) 765-1823 effp ® �t 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. 1978-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner TURNER, ROBERT W. Mailing Address 1 P. O. BOX 296 Mailing Address 2 . City St Zip MATTITUCK NY 11952-0000 Property Address 1 ALBO DRIVE Property Address 2 . -City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-5032 Tax Map No. section 126.00 block 3 lot 17.000 Cross Street WELLS - Date Of Last Pump Out 0/00/00 Issue Date: ,9/25/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) j OFFICE OF THE TOWN CLERK �S\\FFO(,-�'- '- Town of Southold_ �% ,, • CQ Application No. /917 ND Judith T. Terry, Town Clerk .` it '4.r :; �► Town Hall, 53095 Main Road ~ " ` .�. .4 $10.00 - Residential P. O. Box 1179 � ,61-Y,' �uN'u= � 4�. '� , $25.00 - Non-Residential Southold, New York 11971 O._J®el -^,:4' �$ Telephone ' 1- ,�� 'e: (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION • for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. , Fee $ • DATE g — i - J OWNER NAME: -RO‘L�722 GIJ. LLI2,ULJ//e..___ OWNER MAILING ADDRESS: Po -I©s , a-qc 44 1 /tL iC' iv •y, //96-9- - - OWNER- PROPERTY ADDRESS: /9 L,6(;) - OWNER TELEPHONE NUMBER: a/9 ,F' (-__S-D& ' TAX MAP NO. : Section 6 Block 2 Lot f 7 -CROSS STREET: I/vC_-2-(,5 .TYPE.OFESYSTEM: Septic Tank New Existing Cesspool ,/ New Existing ' Residential ✓ Non-Residential DATE OF PREVIOUS PUMP-OUT: Aiztvira,___-- 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.) (1--: 4r_,O.-tt/c-4W- ,.1` Signature of Applicant , RECEIVED BY: - lT a k's Office DATE SEP 190 - - - • Town Clerk Souttiotd e 'i5,t, -170 1k6t/t.5i,? 1-1..36 3,-L Lilwr.,_LLS