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0114 ,
is
, Town Hall, 53095 Main Road
�, P.O. Box 1179
®� its ®0!� Southold, New York 11971
JUDITH T.TERRY ' i�Iv FAX(516)765-1823
TOWN CLERK TELEPHONE.(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. 997-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner WEBB, CLARENCE A.
Mailing Address 1 BOX A U
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 207 KNAPP PLACE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-1316
Tax Map No. section 34.00 block 3 lot 12.000
Cross Street BAILEY AVENUE
Date Of Last Pump Out 0/00/84
Issue Date: 2/01/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �c��FMA' - '
Town of Southold c , e4--_, Application No.`2/I�
�
Judith T. Terry, Town Clerk % Pill?' r ►
Town Hall, 53095 Main Road l Residential
P. O. Box 1179 ` Wz ' r, i , Non-Residential
Southold, New York 11971 c:,,,,` �Y' , %`%
Tel 0.( . �� `�•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
US
Fee $ /0
DATE , /i /c?9'
17f`
OWNER NAME: C1(,�rc.-es/' R.° 02441'
OWNER MAILING ADDRESS: 0....,
(tA0 /Pt -)-7,k 1 igt7ici
OWNER PROPERTY ADDRESS: ,a6 , _,, / _ •QUZ2a , , //,9 OW—
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OWNER TELEPHONE NUMBER: ct6a L(7,7- /3 /C
TAX MAP NO. : Section `�' Blk 3 Lot /Q
Kia„r.r_CROSS STREET: pew.... --Rcej,, A��
V
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: e ) �' u n, J96F4'
LOCATION MAP: Must be attached hereto before ermitbe issued.
p may
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
%Vet, C.Q...- 1 .
Signature of Applicant
RECEIVED BY: M'- y. rv.„_.,Town Cle 's Office
DATE:
- I
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Mrs. Clarence A. Webb
207 Knapp PIace, Greenport, New York 11944
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