HomeMy WebLinkAboutWaite Town Hall, 53095 Main Road
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'-Y4° 1 P.O. Box 1179
•# Southold, New York 11971
JUDITH T. TERRY '���� ��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. 1057-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner WAITE, HELEN
Mailing Address 1 1135 OAKLAWN AVENUE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1135 OAKLAWN AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3005
Tax Map No. section 70.00 block 3 lot 1 .000
Cross Street JERNICK LANE
Date Of Last Pump Out 0/00/00
Issue Date: 3/22/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
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OFFICE OF THE TOWN CLERK cv�FUC,r '
Town of Southold Application No./0(5
Judith T. Terry, Town Clerk ; y
Town Hall, 53095 Main Road
r ti Residential
P. O. Box 1179 V fti ; Non-Residential
Southold, New York 11971 O 411‘ 11t•
Telephone j
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE ,/ //
OWNER NAME: a ew CtCreEck2J
OWNER MAILING ADDRESS: 11 0 5 ( L 4 _�7> l `11_24 cm• cr '
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OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 57 6 76 c 3605--
a Oo5
TAX MAP NO. : Section 7 O Block t Lot
CROSS STREET: ).,12.__))
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool x New Existing
Residential )(, Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
Signature of Applicant
RECEIVED -B Y •
=E 1f Clerk's Office
DATE: MAR 21 1989
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