HomeMy WebLinkAboutWilson ►I'Igg,/ „,, i#g
_ .L
A .; �; Town Hall, 53095 Main Road
® ��� P.O. Box 1179
-- `��®;►► Southold, New York 11971
r
JUDITH T. TERRY ���"l ��i' 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. 1054-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner WILSON, EARL T. & VERA K .
Mailing Address 1 MAIN ROAD
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 CEDAR BIRCH ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2583
Tax Map No. section 15.00 block 8 lot / 9.000
Cross Street MAIN ROAD
Date Of Last Pump Out 10/29/83
Issue Date: 3/17/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.
OFFICE OF THE TOWN CLERK c�vFFD(,r�
Town of Southold ;;. CQ ' Application No. i
Judith T. Terry, Town Clerk r %; :"4:'
Town Hall, 53095 Main Road Residential
P. O. Box 1179 cry .4 r.,.� i • Non-Residential
Southold, New York 11971 Off® ` � '��$
Telephone ( It 1.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. «-
Fee $ •
DATE
• OWNER NAME: /d 4 U QJIC_ K. l:6
OWNER MAILING ADDRESS: u -A
Hy, 7 1 9 (57
OWNER PROPERTY ADDRESS:
L - / N� . ) ) 96 7
OWNER TELEPHONE NUMBER: g") (D --- S __ r ` �--� b : - ,
TAX MAP NO. : Section 1 Block Lot
CROSS STREET: \ aa-"JlC nl wk P<A -
TYPE OF SYSTEM: Septic Tank New Existing 1-'7
Cesspool New Existing
Residential I/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: I O --- `
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: ,j +c� r � e
n bClerk' s tiffice
. DATE: •
- : - _ .
:
,.: , - ..- _
CP
-' :1\t' : . , .
_. = - ._ = . art _ - -
} -- i _