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Home My WebLink AboutWheeler (2) 4 II4f OIKc( JUDITH T. TERRY ; Z Town Hall, 53095 Main Road TOWN CLERK P P.O. Box 1179 to �� REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER O� y •� Fax (516) 765-1823 �y ��®. •.$ 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. 3144-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner WHEELER, ROBERT AND LINDA Mailing Address 1 3500 BOISSEAU AVENUE Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 48000 COUNTY ROAD 48 Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-1i50 Tax Map No. section 55.00 block 3 lot 8.000 Cross Street BOISSEAU AVNEUE Date Of Last Pump Out 0/00/00 Issue Date: 11/19/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) ,,•OFF tE OF THE TOWN CLERK COFOut- '- Town of Southold CQ ' Application No. 3l"(7 Judith T. Terry, Town Clerk % to Town Hall, 53095 Main Road $10.00 - Residential v P. O. Box 1179 ' fis $25.00 - Non-Residential Southold, New York 11971 �� Telephone *Oros:Y►�o (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE //°//6/ 9°3 OWNER NAME: U * a' L _ - 1 JLt_ r OWNER MAILING ADDRESS: &SR)O BOLES eetck ] -. & -1--L /.d t /U,,li _ 119-z/ OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: (�;$= J / S d TAX MAP NO. : Section 55, Block Lot a CROSS STREET: 12+ kl TYPE OF SYSTEM: Septic Tank New Existing Cesspool r,% New Existing V Residential ✓ Non-Residential DATE OF PREVIOUS PUMP-OUT: /01q3 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.) (4,-le. Sign ure of Applicant RECEIVED BY: Town Clerk's Office DATE: //--16 , • . --------- , - . . ., - - .. . • ___ . . . . • • . . , . . . - . . . . . _ . : • . ............................................... ....— . _ _ -. - . . • . , . . , . '' ' • - - . • -, . • . • • . _.. . ,-• . _ • . . . - - • . - ....- • . ..._ ,. • • --,„• .. .„.. , • . . ,: - ...„ . . • - , • . . . . . - . - .- • - ., . • -.. . . . . _- .-• . . _ - . • :• . . . . .., • -/ . . / . - ' • - - . . • . . , -- 44 .- . .. . . . , , . . ... ..• CR.124L 1:; 4 h4C7 -. • - . .- . , . . . ._ . .. .- . . . • • . . • .. . . . -. •, - .•,.• • - ' ,:. . - ---. • -. . . . . . . ,. . , • .- - '-'' •- : • , . - • .. . .... .. , . - ..• ... .., . • 5, 6-1-7C8 qC7" : . .._ . ' •••• ----; „. . • , . .. , . . . . . . . . . . . . . ..,._ , • • _ . • f.!.." . • v, ,, .- .. 0 . veoeyfocsi I _. • t3 , . 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