HomeMy WebLinkAboutVan Mater Qty �` •'-r 11�7�/I�/�/V/ai��'-
" Town Hall, 53095 Main Road
P.O. Box 1179
W9 6 � Southold, New York 11971
JUDITH T.TERRY _ ®i /i��) TELEPHONE
TOWN CLERK � (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. 840-R Residential X Non-Residential
Fee $ 10. 00 Septic ' Cesspool X
New Existing X
Name Of Owner VAN MATER, SHIRLEY
Mailing Address 1 BAYVIEW ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 BAYVIEW ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2743
Tax Map No. section 88. 00 block 1 lot 6. 000
Cross Street GIN LANE
Date Of Last Pump Out 6/00/86
Issue Date: 9/16/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK - '� - •
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Town of Southold T (\CSFe(,�1, NO':, -�," .� , Application No.
Judith T. Terry, Town Clerk .�x r G
Town Hall, 53095 Main Road a *, r .
Residential
F`. 0. Box 1179 cn �°�
',44 �4,�C Non-Residential
Southold, New York 11971 p `'®3% =. % ` I•
Telephone ei. ����°•,
(516) 765-1801 ,-,2-R ' .
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
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'EC ,
AUG 3 01988 OPERATION PERMIT , •
,� ClerkSouthold SEPTIC TANK or CESSPOOL
Operation Permit
Fee $ t U
DATE 2$t " '" '
ONlNER NAME: L, _ A1
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OWNER MAILING ADDRESS. �U 1e-
S r.r-t-H oc.- i WY /1997/
OWNER PROPERTY ADDRESS: t
OWNER TELEPHONE NUMBER: 6'1(g &-r-- -14-is
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TAX MAP NO. : Section d p Block / Lot 6 ,.,
CROSS STREET: G /A) 4 q N L-'
TYPE OF SYSTEM: Septic Tank _New Existing
Cesspool V f
New Existing
Residential N% Non-Residential
DATE OF PREVIOUS PUMP-OUT: le,
LOCATION MAP: Mustbeattached he to beforepermit maybe issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.) °4
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Signature of Applicant
RECEIVED BY:
T;, r`: (= k's Office
DATE: S=P 1 6 1989
Town Clerk Southold
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