HomeMy WebLinkAboutWren 4qvt,
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z Town Hall, 53095 Main Road
:trs `' P.O. Box 1179
efttp ��, Southold, New York 11971
VD
JUDITH T.TERRY
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. 759-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner WREN, JANE M.
Mailing Address 1 BOX 852
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 SOUNDVIEW AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4006
Tax Map No. section 94.00 block 1 lot 16.000
Cross Street OREGON ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 7/19/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK0017 �Q
Town of Southold � Application No.
Judith T. Terry, Town Clerk i k4- _
Town Hall, 53095 Main RoadResidential
s
P. O. Box 1179to ` `
*� �y �,: ���' Non-Residential
Southold, New York 11971 Ohio 0�
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /a
DATE
OWNER NAME: OJ `C_ -Cif)
OWNER MAILING ADDRESS: &t ,( ?S?
allifk(AC -Sys /I qa
OWNER PROPERTY ADDRESS: A-= SOU r) l J lc' ,
�y e,
LK
OWNER TELEPHONE NUMBER: ®` WOO C, 5173® eteCeV
TAX MAP NO. : Section /1 " Block (f Lot
CROSS STREET: 0b-r- frva.—'
TYPE OF SYSTEM: Septic .Tank New Existing
Cesspool New Existing y
Residential Non-Residential
DATE OF PREVIOUS' PUMP-OUT: /V C (J
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.)
ignature o- Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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5.65'06'W.- 074.I3
/ih/ AVENUE
lin-ii Ur,rrr t'i alt•:ration or addition
to this-urvey Is a violation of
Se,-von 7209 of the New York State
Er'rrcetirn Lew.
,',,X.;,,,,,...' vN
Coof this survey map not beefing
"Iz•'-,.' pus the land surveyors inked seal or
' embossed seal shall not be considered
;' MAP OF PROPERTY to be a valid true cony.
SU RV EYE D FOR Guarantees md'cated hereon shall run
only to the person for whom the survey
,s prepared.and on his behalf to the
HENRY W. MATH L E N E. J R •. title company,governmental egenev and
tencirnp,institution listed hereon end
,,o We assignees of the lending Inti-
. ruer)n•Guarenteas aro not transferable
- S lT Li PTE AT •rdwcr.al institutions or subsequent
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MATTITUCK
•{r. 60A2ANTEEO TO NOME TITLE 6uAeActrY
;,:;,.; NEW YORK. COMPAN'I , AND,Tti e4O0.TH FOE,K SANK-
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:2 ,;,''`r i" e.11$T CO., AS SOZ.VEY!`O .
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_• SCALE; 900%= In
LICENSED 5uR.VEYoR•S
GREENpoR-r . N. Y..
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