HomeMy WebLinkAboutWickham •.. l,,,,,, Ii-''
Town Hall, 53095 Main Road
$#*.$ P.O. Box 1179
i Southold, New York 11971
JUDITH T. TERRY '-.,,, �' 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. 1086-R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
New Existing X
Name Of Owner WICKHAM, ROBIN P.
Mailing Address 1 P. O. BOX 520
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 NEW SUFFOLK AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-9314
Tax Map No. section 115.00 block 3 lot 25.005
Cross Street MARRATOOKA AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 4118189 Judith T. Terry
Southold Town Clerk
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(TOWN SEAL)
OFFICE Of THE TOWN CLERK 0%IFN,(
Town of Southold Application No,/O cr,6
Judith T. Terry, Town Clerk y
53095 Main Road a a�+. I Residential
Town Hall, cam ., �• r
P. O. Box 1179 `• Non-Residential
Southold, New York 11971 u`sO • '= Ose
Telephone ='0 '
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
4.gyp
MAR 171989
OPERATION PERMIT
''OW ,tea
SEPTIC TANK or CESSPOOL
Operation Permit No. ft
Fee $ 10 . 00
DATE olv o /'
OWNER NAME: 04
OWNER MAILING ADDRESS: ife). 6 6.4ZO
OWNER PROPERTY ADDRESS: Alm, j, �. � GGA ,
C1 / �'1 119s-a
OWNER TELEPHONE NUMBER: 29V-'7 3�'/ f
TAX MAP NO. : Section Block
CROSS STREET: &.
TYPE OF SYSTEM: Septic Tank A" New Existing O`
Cesspool New Existing
Residential /X 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 BY: 4vLc c Q
own (Clerk's Office
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DATE:
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`-��� No263 ,�,°� medford, new york 11763
SFo LD s�� (516) 756-595
January 29, 1988 Job N2 88-2031
AREA: 57, 427 SO. FT. 0.3/83 Ac.)
1000-115-03-25.2,25.3,25.4Scale: lu=40'
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