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Home My WebLink AboutZahra •{ '�� i %'^fie �t_f� �s�� :.� ` Town Hall, 53095 Main Road R '3 74Y. P.O. Box 1179 '1`,;0 Southold, New York 11971 sir �y - JUDITH T.TERRY . Aviv TELEPHONE FAX A (51 )16)765-1823 7651801 TOWN CLERK 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. 1024-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner ZAHRA, RICHARD AND MARIA Mailing Address 1 23 WOOD AVENUE Mailing Address 2 City St Zip ALBERTSON NY 11507-0000 Property Address 1 445 MARLENE LANE Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-741-4511 Tax Map No. section 143.00 block 3 lot 29.000 Cross Street MAIN ROAD Date Of Last Pump Out 7/20/88 sem•:, -1 Issue Date: 2/15/89 Judith T. Teri' Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK cOMA' -- Town Town of Southold Application No./6 -2,y Judith T. Terry, Town Clerk �` x `• Town Hall, 53095 Main RoadResidential P. t-1 O. Box 1179 � ''_ ; ` •� '� `' Non-Residential Southold, New York 11971 OO' 0��` Telephone : .� `� 0 .'� , (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE 24/ y OWNER NAME: I'\ t c.kq,-cl d Na-r• 2. OWNER MAILING ADDRESS: o o J Lt ue i- I b-eN, ALL/. , l4"07 OWNER PROPERTY ADDRESS: (744-/S- �4I�-- /e /tom •L2 • R-1i--,c -c-Le-/� /" ,/¢,,--Z OWNER TELEPHONE NUMBER: --CA' 7 (-/G � — TAX MAP NO. : Section / '-/ 3 Block 3 Lot CROSS STREET: /1/41/(i- /v '120 TYPE OF SYSTEM: Septic Tank New Existing / Cesspool ✓ New Existing Residential ^ Non-Residential DATE OF PREVIOUS PUMP-OUT: 7 - 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 Applicant RECEIVED BY: Town Clerk's Office DATE: . (S/ rY3- 3 "zj z4 H-/Z11- w / S iMA-2LE4J& L�9 Mcrt W 11 Id ci NI `4-2L C ry E L, �}-- (s) -" /Av©4%?