Loading...
HomeMy WebLinkAboutUry t - ,oigUFFOL,tG,\ JUDITH T.TERRY �� ' yL .4 Town Hall, 53095 Main Road TOWN CLERK t P.O. Box 1179 ^7 11 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS © �1 Fax(516) 765-1823 MARRIAGE OFFICER 'y�lJo [ .0- Telephone(516) 765-1800 RECORDS MANAGEMENT OFFICER d �` .� FREEDOM OF INFORMATION OFFICER ,�,,.• OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL - Operation Permit No. :3433-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner URY, ARTHUR Mailing Address 1 3750 STILLWATER AVENUE Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 3750 STILLWATER AVENUE Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-5308 Tax Map No. section 137.00 block 1 lot 12.000 Cross Street TRACK AVENUE Issue Date: 2/13/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK 'c��FFU(,�, - Town of Southold Q C � '; Application No, 5/g,3 Judith T. Terry, Town Clerk �� 'G - Town Hall, 53095 Main Road a $10.00 Residential P. O. Box 1179 u' �`' $25.00 - Non-Residential Southold, New York 11971 Off` 0��$ Telephone V.( • * y1� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION - - for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ JO/ DATE // / ' OWNER NAME: OWNER MAILING ADDRESS: 37' XSA,,nfle4 ao-e_ k -- )704 , i 1 3 OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: ,g76 — 7 34- ‘3© L(73729 /37, / — /2 TAX MAP NO. : Section 137 Block ( Lot J 2-- CROSS STREET: fJ Aver TYPE OF SYSTEM: .Septic Tank New Existing Cesspool New Existing 4' Residential Non-Residential 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.) • Q-AlL (V( Signature of •$.plicant RECEIVED BY: Town Clerk's_ Of is DATE: ./S---/ 61"/6 w N o kk/1/4) PktCR r Y \ " e t