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HomeMy WebLinkAboutWright VOUre- 1 V JUDITH T. TERRY Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 �� Fax (516) 765-1823 MARRIAGE OFFICER s O ®� • ----IW� $V � Telephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3148-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner WRIGHT, JOHN F. AND CAROLYN F. Mailing Address 1 P. O. BOX 979 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 2715 BRAY AVENUE Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-8536 Tax Map No. section 126.00 block 9 lot 12.000 Cross Street PECONIC BAY BLVD. • Date Of Last Pump Out 0/00/00 Issue Date: 11/19/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) • OFFICE OF THE TOWN CLERK c0F14� a Town of Southold �� ;: CQG' Application No�J 9 Judith T. Terry, Town Clerk . � ' v y�', $10.00 - Residential Town Hall, 53095 Main Road .� P. O. Box 1179 u' ' T► : $25.00 - Non-Residential Southold, New York 11971 Telephone �( NO I. (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE OWNER NAME: 'O , ��r �_ �� 1i\K OWNER MAILING ADDRESS: ,\`c•—\Q\ OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: 9\%, S 3 TAX MAP NO. : Section ` `Q-A Block C\, Lot - CROSS STREET: Vs ®\-k--N\ �jts, TYPE- OF SYSTEM: --Septic- Tank New Existing Cesspool x New Existing Residential )( Non-Residential DATE OF PREVIOUS PUMP-OUT:_ \K `1 � °— \•c'S -\\ \DW`I.Nr , 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.) •\ )\\? 10 411167. \ ignature o App scant RECEIVED BY • v. -�. ;.; CIe k's Of ice DATE: • NOV W5 ?ova Sallitr! Cr) Pi 47/ 3 (