HomeMy WebLinkAboutWiggs •
fr-TO Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY _®� `tis TELEPHONE
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TOWN cLERF (516)765-1801
REGISTRAR Oh VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 775-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner WIGGS, SARAH A.
Mailing Address 1 P. O. BOX 123
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 VILLAGE LANE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-3641
Tax Map No. section 24. 00 block 2 lot 16. 000
Cross Street ORCHARD STREET
Date Of Last Pump Out 0/00/00
Issue Date: 8/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK '0��TFD'4-
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Town of Southold �� C'� Application No. 7 7_5
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road 8 r-' Residential
P. O. Box 1179 cn , h, ;/ Non-Residential
Southold, New York 11971 O44
Telephone = 1to
(516) 765-1801
TOWN OF SOUTHOLD
RICIWED SOUTHOLD WASTEWATER DISPOSAL DISTRICT
19 "BB
APPLICATION
- - - for - -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ j� az)
DATE j6 g_, ",/„-7_/,
OWNER NAME:Zz-ip -
OWNER MAILING ADDRESS: �Q•� /23
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OWNER PROPERTY ADDRESS: ,---
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OWNER TELEPHONE NUMBER: 3 c 3 3 40 / �..
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TAX MAP NO. : Section r & Block Lot IA
CROSS STREET: '* AJt _ `�/1� � -( �;f'C' �� �J Sic7n
TYPE
OF SYSTEM: Septic Tank New Existing
Cesspool New Existing ¢V
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT:
r
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.)
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Signature o App
RECEIVED BY:
Town Clerk's Office
DATE:
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