HomeMy WebLinkAboutWoodard ke4, - _ ((*:‘
Town Hall, 53095 Main Road
cf., . P.O. Box 1179
V4.70 ` . •!" Southold, New York 11971
JUDITH T.TERRY .� FAX(516)765-1823
"'�"I TELEPHONE(516)765-1801
TOWN CLERK
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. 1391-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner WOODARD, JUDITH H.
Mailing Address 1 2005 VILLAGE LANE
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 2005 VILLAGE LANE
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-3714
Tax Map No. section 25.00 block 3 lot 11 .000
Cross Street FLETCHER STREET
Date Of Last Pump Out 0/00/00
Issue Date: 2/22/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK c3�FFG(,l, •
2 /
Town of Southold Q C'0 = Application No.
Judith T. Terry, Town Clerk �
Town Hall, 53095 Main Road �y $10.00 - Residential
P. O. Box 1179 v7
� 3i ;,�3 � $25.00 - Non-Residential
Southold, New York 11971 O 'er to F`- $
Telephone _Q( �.ao ►o
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE ) I lam'/ ‘7
OWNER NAME: ,114 �; ` . D 11-
OWNER MAILING ADDRESS: u '1lav \
,.e,t., 4)(4 // , s- 7
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: S-76-3?i3 -37/ y
TAX MAP NO. : Section 69,2- 5---- Block (930° Lot 0/(2)CY
CROSS STREET: 44)
TYPE
TYPE OF SYSTEM: Septic Tank V New Existing
Cesspool New Existing
it
Residential V 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 distaInce, approximately, to building and closest road.)
n -71%
iSignature of Applicant
RECEIVED BY: RECD ®
Town Clerk's Office FEBf
DATE:
Town Clerk Southold'
A s1
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