HomeMy WebLinkAboutWilkinson 11
14f Wired:
�® G 4
JUDITH T. TERRY Town Hall, 53095 Main Road'
TOWN CLERK ® T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
`to, Telephone Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2064-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner WILKINSON, ROBERT AND JEAN
Mailing Address 1 3930 OAKLAWN AVENUE-EXT.
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 3930 OAKLAWN AVENUE EXT.
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3897
Tax Map No. section 70.00 block 9 lot 10.000
Cross Street CUSTER AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 3/04/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c�vFFC(,�-
Town of Southold 0� , BO - Application No. cps
Judith T. Terry, Town Clerk m d a � �'` $10.00 - Residential
Town Hall, 53095 Main Road
P. 0. Box 1179 cr's � $25.00 - Non-Residential
Southold, New York 11971 O .: ��`
Telephone
Oj ��� '°.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Lib Fee $ •
DATE 3/3/95
OWNER NAME: 44,gfr e_ee /j) (/c/ /CJ s °Aj
OWNER MAILING ADDRESS: ,3 ? D P,ck J44.04) /2v ' . t k7
- OWNER PROPERTY-ADDRESS. 4s-7,47 e-
OWNER TELEPHONE NUMBER: 766 - g97
TAX MAP NO. : Section / Block 70," 91- 9 Lot
CROSS STREET: i (,',/'S/er I4I, I
TYPE .OF-SYSTEM: Septic Tank - New Existing
Cesspool , New Existing
Residential Y._ Non-Residential
DATE OF PREVIOUS PUMP-OUT:
LOCATION MAP: Must be attached hereto before permit may be issued.
1 (Locate building and system; give north arrow and feet
5 fool of distance, approximately, to building and closest road.)
/Jerrh
0`' 445 4:ne Pei
) Signature of Applicant
RECEIVED' -BY-
Town Clerk's Office
DATE: