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HomeMy WebLinkAboutBrown (7) 121;�I - t:fr. Town Hall, 53095 Main Road P.O. Box 1179 '=_, ® � `Is� Southold, New York 11971 JUDITH T.TERRY '� „i//04° FAX(516)765-1823 TOWN CLERK 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. 1120-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner BROWN, ROBERT W. Mailing Address 1 PRAITY LANE Mailing Address 2 City St Zip CUTCHOCUE NY 11935-0000 Property Address 1 PRAITY LANE Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-6424 Tax Map No. section 109.00 block 5 lot 1 .000 Cross Street ROUTE 25 Date Of Last Pump Out 0/00/00 S Issue Date: X/23/89 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK OcvFFO(,r0'= Town of Southold � �Q Application No. AP-6 Judith T. Terry, Town Clerk It4 .0 Residential Town Hall, 53095 Main Road c=1 zAN �„ P. 0. Box 1179 cn x"A ' i z Non-Residential Southold, New York 11971 O ��`� Telephone 0.( rt (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE 3 — 1 ® ` �S OWNER NAME: 411,0 R C�� ` i(~®CO ) OWNER MAILING ADDRESS: /4-17.-Y L'a -ie© L) IA) OWNER PROPERTY ADDRESS : l/ OWNER TELEPHONE NUMBER: 73 4-1-- to `l c•-ti • 2 TAX MAP NO. : Section jog Block Lot 1 2 CROSS STREET: TYPE OF SYSTEM: Septic Tank / New Existing Cesspool '✓ New Existing v • Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: I!AttiJ. be, k��w 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 of Applicant RECEIVED BY: � 1 Town Clerk's Office DATE: 4- s.oi T Oo/ i