HomeMy WebLinkAboutBrown (3) --
Town Hall, 53095 Main Road
,�� P.O. Box 1179
0," Southold, New York 11971
JUDITH T.TERRY
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oo° FAX(516)765-1823
TOWN CLERK TELEPHONE(516)7654801
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. 1192-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BROWN, JAMES C.
Mailing Address 1 P. O. BOX 630
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 OAK STREET
Property Address 2
City St Zip CUTCHOGUE 11 11935-0000
Owner Telephone No. 516-734-5617
Tax Map No. section 136.00 block 1 lot 52.000
Cross Street HARBOR LANE
Date Of Last Pump Out 0/00/00
Issue Date: 7/25/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
II
OFFICE OF THE TOWN CLERK cwFF01i('
Town of Southold - , CQG• , Appli-
cation No. // -2----)
Judith T. Terry, Town Clerk .• 4
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'fog Hall, 53095 Main Road � G � , ;;: G Residential •
P. 0. Box 1179 v' ' "- r ' h�i ; Non-Residential
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ �'Qs Op
DAT E--12/.14:: Z/ 61
•
OWNER NAME: vI4A1ES' (- /3/ao i'/
OWNER MAILING ADDRESS: ,Vn /3d _40 f
� '�!4/7`� 0 moi- ,t/y //9,3S
OWNER PROPERTY ADDRESS: / AIC�
OWNER TELEPHONE NUMBER: 73 c` ‘ /7
TAX MAP NO. : Section X36 Block / Lot .5-e
CROSS STREET: ./-%/e./, n a L.¢,,/
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: A/C'i/e/2c 0 01l2 kA/0 fiv .i = yks)
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.)
pged/ (2• ¥fir
Signatur 7of Applicant
RECEIVED BY: , /,_
`
Town/ Cll
erk Office
DATE:
JUL aZ '569
, 524141
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