HomeMy WebLinkAboutBurden �$, # „ ,,
�'''c�\ FO(4r
ur3 �,�;� Town Hall, 53095 Main Road
.$ P.O. Box 1179
yb/ * ��� i� Southold, New York 11971
JUDITH T. TERRY '�-��� /Pas lll TELEPHONE
TOWN CLERK (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. 1066-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BURDEN, HOWARD W.
Mailing Address 1 34 MIDDLETON ROAD
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 34 MIDDLETON ROAD
Property Address 2
City St Zip GREENORT NY 11944-0000
Owner Telephone No. 516-477-1917
Tax Map No. section 41 .00 block 2 lot 8.000
Cross Street WASHINGTON AVENUE
Date Of Last Pump Out 10/00/87
Issue Date: 3/31/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK c�VFFQ(�
Town of Southold � � C'�G Application No./2lo66
Judith T. Terry, Town Clerk .• w;
Town Hall, 53095 Main Road `3'r. ;s =4 ) Residential ►O
P. 0. Box 1179 cn � ``.fi°�' hzi
4 's ,1g? : Non-Residential
Southold, New York 11971 O ® ' ` •`
Telephone _ol s'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /1)- 61 U
DATE 3 ` 27/Y
1
OWNER NAME: ��,--) 9rc( W , Qe v
OWNER MAILING ADDRESS: S9 / 'J c1 )eTcY\ ko4cJ
a r-eenPA/-7& „Li ,/ // 9 V
OWNER PROPERTY ADDRESS: S'4-/"J(
OWNER TELEPHONE NUMBER: 5-/e— ",/%77--/9/7
TAX MAP NO. : Section / Block c,2 Lot v
CROSS STREET: 4)46 X7/04 10t/G--
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: i®/?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 of Applicant
RECEIVED BY: •
ra9ZISID;iwn Clerk's Office
DATE: MAR 31 NH
Taw
,1 • --1
.., .
6.) .. &e Ole PI 1.' 1-,3 F
Se C4--;e,rN ill
elo c k a 4 )
4 0 r r
— --..-;
rn
/12;6414-4ein 2O--,9 0/
......___
---------1\
i .
C't
'zloty 0,7
I. ......s
—