HomeMy WebLinkAboutYoung (2) •
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JUDITH T.TERRY ��0 Gy
Town Hall, 53095 Main Road
TOWN CLERK ti 2 ; P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS :%4t4
MARRIAGE OFFICER `�y
RECORDS MANAGEMENT OFFICER =�6:( �a0 Fax(516) 765-1823
i. Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3650-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner YOUNG, J. MYRON
Mailing Address 1 P. O. BOX 635
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 3483 PECONIC BAY BLVD.
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-4512
Tax Map No. section 128.00 block 3 lot 21 .001
Cross Street
Issue Date: 6/20/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i
OFFICE OF THE TOWN CLERK Of�FFO
Town of Southold , ��� coG Application No. 3‘:"(°
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 � , '. }-' ��`i $25.00 - Non-Residential
Southold, New York 11971 OO i�`
Telephone _ ( Y►
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD' WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ �(,Q 06
DATE q7
OWNER NAME: j , Al)/rim Yc�h5
OWNER MAILING ADDRESS: p,D, 2, y /t Y // '?, '
OWNER PROPERTY ADDRESS : 3 5.1 3 "z_Gew1 /C 50-3/ jS//�.J
N )( 1/61VV/
OWNER TELEPHONE NUMBER: $7
TAX MAP NO. : Section / )-.65' Block 3 Lot /.
CROSS STREET: /0_e_ � ;G &.) JS 4,J
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool [/ New Existing G-
Residential (/ 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.)
Sigfiature 1plicant
RECEIVED BY:
Town Clerk's Office
DATE:
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