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HomeMy WebLinkAboutWilliams (3) sifY � : JUDITH T. TERRY ., Town Hall, 53095 Main Road • TOWN CLERK 6 ti P.O. Box 1179 REGISTRAR OF VITAL STATISTICS rgrb Southold, New York 11971 MARRIAGE OFFICER ® �r' Fax (516) 765-1823 ®�4! Telephone (516) 765-1801 rcli *4OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1857-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner WILLIAMS, MRS. HADLEY B. Mailing Address 1 (MRS. B. WHEATLEY WILLIAMS) Mailing Address 2 13606 ALEPPO DRIVE City St Zip SUN CITY WEST NY 85375-0000 Property Address 1 10725 NEW SUFFOLK AVENUE Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 602-546-0146 Tax Map No. section 116.00 block 1 lot 5.000 Cross Street MOORE'S LANE Date Of Last Pump Out 0/00/00 Issue Date: 3/20/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) • OFFICE OF THE TOWN CLERK �cj1FUL4-CQG'` �tf5 Town of Southold �� .•, .. ,, Application No. Judith T. Terry, Town Clerk Ee Town Hall, 53095 Main Road $10.00 - Residential a p. O. Box 1179 r;=; H z` $25.00 - Non-Residential Southold, New York 11971 •te " Telephone -.7e11;& �� '�• (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ � • DATE hm-,2_ OWNER NAME: A1s. LE-7 B_ 11, I Li-IA S ,es. .1U/464r-67iflzi 1- us OWNER MAILING ADDRESS: /3464 ASG--i po 2Ifl1 SiJCrryI.z1�� 2, 3 OWNER PROPERTY ADDRESS: /b 7 6 (J,C/=dLk /Iva Curt(1--z5G-u6 N.1 /193s OWNER TELEPHONE NUMBER: (/ga y qq 0 /4/6 &z ) TAX MAP NO. : Section / f ) Block ( Lot ,ST CROSS STREET: �y ��l�l Li r'� e�a� �bZo Id. 'Ai 0611,E'Sa II-,11T TYPE OF SYSTEM: Septic Tank New Existing VCesspools New Existing Residential >c Non-Residential DATE OF PREVIOUS PUMP-OUT: Ap/Lees„,e); i,; — 0.2% J 2,44 . 2 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.) 01: I , / Signature of Applicant ,,er �, /JILL/4/244 RECEIVED BY: Town CI rk's Off'ce - RECEIVED. - DATE: MAR 2 0 1gc° Town Clerk Southold /1-Nmck1 dTy(J,; Sozve-y( 4/2 (97 I 5 Q 1-40 8. Gu.,/ mac tott-64l l to�/ fii(4,4 5 ° �T -WOI1�d=dt-rd p____,_, G,, e[toALL, iv. . Blit .)�, �/ � P �11Vv,/t__ i ce_} }d' rl Cod`' �. v I r 16 I Il y6 ` i>., 0 isfGSI( jG .r- /3 )‘1 il • pi-c-1 ---... fi 1 i tly ..----)-- --- ---- 1 31 -k, y i6r II' /y' 1, ,\; T I lb. qaysii ._._.____________. 1 4' -1(-494Q- CLAY Q.,((t 4,5 14 ' 2,3, � ` �a i4Ili I AI'1. � GIS boviA __, ( ,7 ( 7o VI