HomeMy WebLinkAboutCardinal ,
JUDITH T. TERRY '`_ Town Hall, 53095 Main Road
TOWN CLERK s = P.O. Box 1179
REGISTRAR OF VITAL STATISTICSi `p, �i Southold, New York 11971
MARRIAGE OFFICER ;-� >;, Fax (516) 765-1823
, Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1605-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CARDINAL, DOROTHY
Mailing Address 1 58305 MAIN ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 58305 MAIN ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3124
Tax Map No. section 56.00 block 2 lot 1 .000
Cross Street LAUREL AVENUE
Date Of Last Pump Out 0/00/84
Issue Date: 1/17/91 Judith T. Terra
Southold Town Clerk
(TOWN SEAL)
t?FFICE OF THE TOWN CLERK Oc3VFFo(,(,C;-
Town of Southold - Application No.
Judith T. Terry, Town Clerk % h ,-0;:47.1'k,7 ';',1,..-0, 0t.‘
Town Hall, 53095 Main Road g % --'''''.‘;::;-4-; :4 $10.00 - Residential
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O. Box 1179 �.°�`-•: . .�-`?�„;* �` $25.00 - Non-Residential
Southold, New York 11971 O .`$ ''K �$
Telephone Q( lis.��0 ���
(516) 765-1801 _
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- 4 for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE /VAA
'OWNER NAME: OD l_..--/9', -! •
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OWNER MAILING ADDRESS:/ 51'3 0 5— /4a, BA,
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OWNER PROPERTY ADDRESS-:-- - / /J2 j',---29-S hige -!/%
OWNER TELEPHONE NUMBER: S/l - 7105-- V. y
TAX MAP NO. : Section S4 Block g- Lot / -
CROSS STREET: •.,=,,e,,,,e,..,e..." a.,.-e-L.—r,..-e----
TYPE "OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential Non-Residential r
DATE OF PREVIOUS PUMP-OUT: 4:4-e-7- q o-L 6 P c"
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.)
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Sig ture of Applicant
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RECEIVED BY: W� . ' .
own Clerk's Office
DATE: /24(3 ! lav
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