HomeMy WebLinkAboutBrown (6) offloIr
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- Town Hall 53095 Main Road
o P.O. Box 1179
�-, •
,ss Southold, New York 11971
JUDITH T.TERRY 3-
FAX i�� FAX(516)765-1823
TELEPHONE(516)7654801
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. 1266-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BROWN, ROBERT J.
Mailing Address 1 900 BEACHWOOD LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 900 BEACHWOOD LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1933
Tax Map No. section 70.00 block 10 lot 58.000
Cross Street CRITTENS LANE
Date Of Last Pump Out 0/00/00
Issue Date: 10/12/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
:.l
S III .
OFFICE Of THE TOWN CLERK 0 ��� ,c- /
Town of Southold a- 0 = Application No. / 6 to
Judith T. Terry, Town Clerk '�.4
O
Town Hall, 53095 Main Road r4 $10.00 - Residential
p. O. Box 1179 cn A s �
$25.00 - Non-Residential
Southold, New York 11971 0 ® ,
Telephone :Q( `1�
(516) 765-1801
TOWN OF SOUTHOLD'
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE /6//2- /P7
i
OWNER NAME: 'W r z. ,t1 �1 i TQC.✓ •
•
OWNER MAILING ADDRESS: 900 fl/747 /4'DQL) L, i(
�C c/ 7-iO L-- f_ /!/T 11 cf 7/
OWNER PROPERTY ADDRESS: __` _/44
OWNER TELEPHONE NUMBER: ,‘ ‹.. / 3 3
5
TAX MAP NO. : Section 70 Block /0 Lot .P:1-----7. '
CROSS STREET: /`g�'�Q C,li�Qp0 LAS C-le--;l /�n/s' LAA/11
TYPE OF SYSTEM: Septic Tank New Existing IV-
Cesspool New Existing //
Residential J/' Non-Residential
•
DATE OF PREVIOUS PUMP-OUT:
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.)
f � i
d I
Signatu! of Applicant
RECEIVED BY: .00/1- �—L___-- —
Town Clerk's Office
DATE: /6//Z C/ r?
,.nz Sur.VtT IS A vIOLATION OF - - -� - - -- ._ -
SECTION 7209 OF THE NSW YORK STATE -
EDUCATION LAW. /
,- / COPIES OF THIS SURVEY PPF NOT BEARING _
/ THE LAND SURVEYOR': ., D SEAL OR
EMBOSSED SEAL SHALL n CE CONSIDERED •- ' I
TO BE A VALID TRUE CCFr _ -1
I
— GUARANTEES INDICATED i;,C•)N SHALL RUN ��Y�T'" i
ONLY TO THE PERSON FOr , / r. �- -�.
IS PREPARED, M THE SURVEY
AND ON,y.S L.,'LE TO THE j
TITLE COMPANY, GOVLR,,`-...1-LENDING INSTITUTION LISTCL 1,4�s_UN,IANDA� /C, / ''l_-
- II
TO THE ASSIGNEES OF THE Ln DING INSTI-
Q TUTION. GUARANTEES ARE NOT TRANSFERAi� / I
B i;_. • TO ADDITIONAL INSTITUTIONS OR SUBSEQBI�U / I '
_'.1
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O/WNERS.
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