HomeMy WebLinkAboutWatson JUDITH T. TERRY �� Town Hall, 53095 Main Road
TOWN CLERK � P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER
..® Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1874-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner WATSON, MAY
Mailing Address 1 P. O. BOX 533
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2400
Tax Map No. section 18.00 block 6 lot 24.001
Cross Street BROWN'S HILLS ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 4/09/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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'OFFICE OF THE TOWN CLERK .cvFFOUr -" ,
Town of Southold CQ Application No. ./? I
7 S
Judith T.. Trry, Town Clerkf Z ►�'
Town Hall, 53095 Main Road " ary: < $10.00 - Residential i/
�
p. O. Box 11,79 tit:'
S: $25.00 - Non-Residential
Southold, New York 11971lee:O s_
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 411 lq V
OWNER NAME: W),,LiWt'' oY\
OWNER MAILING ADDRESS: f't- ) l q(ci
OWNER PROPERTY ADDRESS: 4Q�J► ° NJa t -
OWNER TELEPHONE NUMBER: 3D.DJ-D-T® 0
TAX MAP NO. : Section Block fo Lot
CROSS STREET: Itii� \L�
TYPE OF SYSTEM: " Septic Tank New Existing
Cesspool New Existing
Residential V 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.)
Si nature of Applicant
9 pp
RECEIVED BY:
Town Clerk's Office
DATE: