HomeMy WebLinkAboutCaplan 04 S4rkk'tt"„
f •
4 4iP)
1 ill Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY d ��I
�� 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. 703-R Residential X Non-Residential
Fee $ • 10. 00 Septic Cesspool X
New Existing X
Name Of Owner CAPLAN, MARY Z.
Mailing Address 1 42 50 81ST STREET
Mailing Address 2
City St Zip ELMHURST NY 11373-0000
Property Address 1 BAYVIEW ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 718-457-0489
Tax Map No. section 78. 00 block 4 lot 33 .000
Cross Street COREY CREEK LANE
Date Of Last Pump Out 3/07/82
1s/
Issue Date: 5/16/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i
OFFICE OF THE TOWN RK cwVFair 3
Town of Southold �% t CQ - Application No. 70
Os. G
Judith T. Terry, Town erk k A Ate. ,� .
Town Hall, 53095 Main i ad " -G Residential
P. O. Box 1179 �60 ` Non-Residential
Southold, New York 11,971 ®�`•® '%`= �$%
Telephone ' _
(516) 765-1801 ®1
TOWN OF SOUTHOLD
RECEIVED SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APR 151988
APPLICATION
Town Clerk Southold _ __^
---- for . -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /t
DATE Ritv( dOW
OWNER NAME: linty Z. C/#,-64,")
OWNER MAILING ADDRESS: AO- O f/JI.
e L/IA(4- ? -/U.Y. /13 73
OWNER PROPERTY ADDRESS: giA7 yi ci.,, go 0
Gro uektoLP Ay . / 197/
OWNER TELEPHONE NUMBER: 7f1� .W7.--- •0
TAX MAP NO. : Section ii Block 4 Lot 33
At
CROSS STREET: = ;1-„ ,- - L C/t_ee_'
Q
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓/ New Existing
Residential N n-Residential
;LOCA- DATE OF PREVIOUS PUMP-OUT: 3 7/;°-
LOCATION
TION 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.)
keit.r .-
z
IP k
ign ture of A. .licant
RECEIVED BY:� Q,
R` .1 wn Cork's Of ice
DATE: MAY 161988
. , Tom MO(( S® rd -
r i; '1-
• ' •t
•
(-9(7'1
Ci
qo
xl///z/70
w
.• t
J.`
1
1