HomeMy WebLinkAboutYoung L.
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�.` Town Hall, 53095 Main Road,
O ®�, '' P.O. Box 1179
= �� 7011''��� Southold, New York 11971
JUDITH T.TERRY � FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1312-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner YOUNG, HELEN S.
Mailing Address 1 P. O. BOX 341
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 HOBART ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-2275
Tax Map No. section 64.00 block 3 lot 5.000
Cross Street TERRY LANE
Date Of Last Pump Out 0/00/00
Issue Date: 11/17/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK SFFD(x '
Town of Southold � CQ • Application No. /3/�
Judith T. Terry, Town Clerk ,
Town Hall, 53095 Main Road $10.00 - Residential
P. o. Box 1179 cn
$25.00 - Non-Residential
Southold, New York 11971 O ® A
TelephoneQ!
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /3/.4.2
Fee $ /b n9
DATE //o V. l 1.. / 9S y
OWNER NAME: HE E N S. ybuiv6
OWNER MAILING ADDRESS: p. of kor 3 l
Saul-Horn,, y 11971
OWNER PROPERTY ADDRESS: !f d, R. ki Ry R
So a -t/-i'O) 1 Ny 1147/
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section A Block 3 Lot
CROSS STREET: HO g7}. -i— Ro
TYPE OF SYSTEM: Septic Tank ,New Existing
Cesspool New Existing
Residential ,/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: L. A/KND Lo n/
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.)
Sign•-ture o6`•t;plicant
RECEIVED BY: aG-n� OiLiaL.3
TowClerk' Office
DATE:
ISI O V 1 7 1989
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