HomeMy WebLinkAboutWoody %,‘JUDITH T.TERRY �� _ Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
1.30 P Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER ��' Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER = .( * `t►a ,,O Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER „ ,01
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3519-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner WOODY, BETTE
Mailing Address 1 159-40 98TH STREET
Mailing Address 2
City St Zip HOWARD BEACH NY 11414-0000
Property Address 1 1760 CHAMPLIN PLACE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 718-845-9045
Tax Map No. section 34.00 block 5 lot 18.000
Cross Street ROBINSON ROAD
Issue Date: 10/02/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
IIS
4OFFI,CE OF THE TOWN CLERK •c31FNA'
Town of Southold •. 0 --.\ Application No y.'
`Judith T. Terry, Town Clerk •
- "
Town Hall, 53095 Main Road $10.00 - Residential 4/
r� yt
P. O. Box 1179 - i � $25.00 - Non-Residential
Southold, New York 11971 ® 0�`
Telephone ( .
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE /J/Q/9‘
OWNER NAME: 7 -� `� 0 y
OWNER MAILING ADDRESS: / $ 9 — O 9 e�—
ld )1. � I ( /
OWNER PROPERTY ADDRESS : f Z 6 CGr, 2 , ,Cac-e
OWNER TELEPHONE NUMBER :/ T( " g-15 - �G �• '
TAX MAP NO. : Section b 3 L Block S Lot /8
CROSS STREET: ga %;.S
TYPE OF SYSTEM: Septic Tank . _New Existing
Cesspool L/ New Existing [�
Residential t Non-Residential
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 Appl ant
RECEIVED BY:
Town Clerk's Office
DATE:
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