HomeMy WebLinkAboutBrigham ffa Enrt ��, Town Hall, 53095 Main Road.
P.O. Box 1179
®� ®���'� Southold, New York 11971
JUDITH T.TERRY FAX FAX(516)765-1823
TOWN CLERK <:�rz�/��` 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. 1318-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BRIGHAM, TIMOTHY J & BARBARA
Mailing Address 1 P.O. BOX 24
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 645 WICKHAM AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-8082
Tax Map No. section 1 .40 block 2 lot 27
Cross Street PIKE STREET
Date Of Last Pump Out 1/01/83
Issue Date: 11/27/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
, I III •
OFFICE OF THE TOWN CLERK �COFO(,r
Town of Southold Q CQ A lication No.
Judith T. Terry, Town Clerk � `'�� SS A' �-
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Town Hall, 53095 Main Road a ,, $10.00 - Residential
P. O. Box 1179 cr� WO, 4:44
i ; $25.00 - Non-Residential
Southold, New York 11971 O0-1/
W $
Telephone (
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
4 .
DATE 7
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OWNER NAME: ( •4� 1` a ST- t,
OWNER MAILING ADDRESS: bvs / /g/r,
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OWNER PROPERTY ADDRESS: gr-41/11/e_ ht/r
OWNER TELEPHONE NUMBER: ,'" 1.5P
TAX MAP NO. : Section WO Block Lot 17--r7
CROSS STREET: ''fir Pi I<'� 5 ie
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: JC/g3
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.)
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KTi ; ign:t �J rlicant
RECEIVED BY: owr��li� �s O fwr�iL)
ice
DATE: ///r9 7///
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Tim and Barbara Brigham
Sketch of,cesspool locations. 111
Not to scale.
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WICKHAM AVENUE
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