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HomeMy WebLinkAboutVesey m ► �� el, O cf.., u' �� Town Hall, 53095 Main Road ��� P.O. Box 1179 �Q( * V��►►► Southold, New York 11971 JUDITH T. TERRY ''-•www_ '1k' 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. 1091-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner VESEY, STEVEN / SCHLITT Mailing Address 1 P. O. BOX 53 Mailing Address 2 City St Zip EAST MARION NY 11939-0000 Property Address 1 2105 OLD ORCHARD LANE Property Address 2 City St Zip EAST MARION NY 11939-0000 Owner Telephone No. 516-477-8548 Tax Map No. section 37.00 block 3 lot 6.000 Cross Street ROUTE 25 Date Of Last Pump Out 0/00/00 Issue Date: 4/26/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) air OFF-ICE OF THE TOWN CLERK FULA- Town of Southoldh �Q�_: Application No. /d Judith T. Terry, Town Clerk Ierk , -`�`�` Town Hall, 53095 Main Road " ~`r .•C ) Residential V P. O. Box 1179 Tts: r 01 ' ;' Non-Residential Southold, New York 11971 4 ® =`%' •` Telephone _©1 :; .h • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /r3 . O DATE ///2-1 OWNER NAME: V L ( < c-a L ►t OWNER MAILING ADDRESS: `30)(. 5 1+",(k ;Z_ I< J ,J. y. I193c' OWNER PROPERTY ADDRESS: 2- 01Z.Gjk-1, A2.b j-A L iv\A . pi OWNER TELEPHONE NUMBER: Li' 1 1 - <6)--"y � TAX MAP NO. : Section 0 3 ? . 00 Block 0 4) . "3' Lot O4'3 . CROSS STREET: L�ZT C' �� TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing I Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: /0/ / S �� �� LOCATION MAP: ust 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.) Signature of A' .l.cant RECEIVED BY: • ownClerk'�e DATE: APR 2 G 'Ms Tem nhrh So- 9d 6-.14a 4 r 1 0�, 5 O L.cc--1 A`+lc_14. . , AiZ. !J 4 � � ,A1',Q1- i 90 ,\ /1t - �J '51 Pa 1 - C;Fl�AL - L- w / I "- ( A/e) Z:1- L - v �� 1^VAd