HomeMy WebLinkAboutWeir . Town Hall, 53095 Main Road
JUDITH T. TERRY s'
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS r � Southold, New York 11971
MARRIAGE OFFICER ® O ,;1� Fax (516) 765-1823
4'4® Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3054-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner WEIR, GERALD AND LINDA
Mailing Address 1 2223 INDIAN NECK LANE
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 2223 INDIAN NECK LANE
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 516-734-6923
Tax Map No. section 86.00 block 5 lot 11 .003
Cross Street LESLIE ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 7/01/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF'THE TOWN CLERK C '/� '
Town �
of Southold %� :: CQG' , Application No. 3
(fLif
Judith T. Terry, Town Clerk .` � x w 'S
Hall, 53095 Main Road -4 $10.00 — Residential ✓
Town � _� ti
P. O. Box 1179 •
to $25.00 - Non-Residential
Southold, 'New York 11971 OO1 �• ���'
Telephone '�l go
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- - - - - ,_ ' .
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No.
Fee $ '
DATE Ni/ J`.�
OWNER NAME: 6 E2 -D 4 .4,/'UOf5' etJE•/,2,
OWNER MAILING ADDRESS: 01 ,2a.3. -7-- /-n)/0,43 NC-c./C
pEG d A)/G A.J �L '// 5.§'?
OWNER_ PROPERTY ADDRESS: 44_02. 3. Z.E)D/? ,i) ,36-c/C
N> // f _?"
OWNER TELEPHONE NUMBER: 47‘, 7G3 or.
TAX MAP NO. : Section g 0 o Block S Lot // DO 3
CROSS STREET: - E0.12-,1)
TYPE OF SYSTEM: Septic Tank : New ✓ Existing
Cesspool ✓ 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.)
(t.„2„6,6„ti
Signature of Applicant`
RECEIVED BY: (A)44
ow ; Clerjes Office
DATE: ;. g 7-- - -
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