HomeMy WebLinkAboutCarpluk JUDITH T. TERRY z L Town Hall, 53095 Main Road
TOWN CLERK p ►� P.O. Box 1179
REGISTRAR OF VITAL STATISTICS un Southold, New York 11971
MARRIAGE OFFICER ‘101
.. 1 Fax (516) 765-1823
44/0/ gga �1D® 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. 2054-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CARPLUK, THEODORE C.
Mailing Address 1 950 MAIN BAYVIEW ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 950 MAIN BAYVIEW ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5286
Tax Map No. section 70.00 block 7 lot 17.000
Cross Street PINE NECK ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 2/22/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE' OF THE TOWN CLERK •c§WFO(,r =
Town of Southold �Ozr - - . Application No. c705"1/
Judith T. Terry, Town Clerk
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Town Hall, 53095 Main Road 1
� $10.00 - Residential
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P. 0. Box 1179 un tr N $25.00 - Non-Residential
Southold, New York 11971 O � �0� ��
Telephone = ( ' .�'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT-ION -
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ fes. —
DATE J/> 3
OWNER NAME:
OWNER MAILING ADDRESS: 9 A47I z .7 ,/r-�
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-OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: / G f— ,�L P G
TAX MAP NO. : Section 74-, Block 7 Lot ,--"/"I'
- - -- - - - -- -
CROSS STREET:
TYPE OF. SYSTEM:----Septic Tank-` ' - - - New Existing
Cesspool New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ///r'Z--
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.)
774p,/,
Signa a of Applicant
RECEIVED_,BY: _
Town Clerk's Office
DATE:•. •
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