HomeMy WebLinkAboutCato JUDITH T. TERRY AT
11, Town Hall, 53095 Main Road
TOWN CLERK ` P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .�• Southold, New York 11971
MARRIAGE OFFICER V1,' Fax (516) 765-1823
- ��® IN� ��!' 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. 3058-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New •Existing X
Name Of Owner CATO, HELEN J.
Mailing Address 1 1407 MIDDLE ROAD
Mailing Address 2
City 'St Zip CALVERTON NY 11933-0000
Property Address 1 2150 NORTH OAKWOOD AVENUE
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-727-6440
Tax Map No. section 127.00 block 6 lot 4.000
Cross Street PECONIC BAY BLVD.
Date Of Last Pump Out 0/00/73
Issue Date: 7/12/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
1
OFFICE OF THE TOWN CLERK c��FFOL,I'.'-
Town of Southold � CQ ' Application No. S�
Judith T. Terry, Town Clerk "' t
Town Hall, 53095 Main Road .:4t � $10.00 - Residential
P. 0. Box 1179 to �. ; $25.00 - Non-Residential
Southold, New York 11971 O � 0���`
Telephone j
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
( OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /6
DATE l‘
OWNER NAME: #6/e-A/ c7 e
OWNER MAILING ADDRESS:/51O/ x®26 q12 e9/ - y
OWNER' PROPERTY ADDRESS; ,74/6/5-0 ,A O 49029A' e-d 0 /7-1/2;51
//9Fer
OWNER TELEPHONE NUMBER: //vim •1?7-- /fze)
TAX MAP NO. : Section
/rA Block 4 Lot
-
CROSS STREET: i/i/ yj( ''
TYPE OF. SYSTEM: Septic Tank - - New Existing
Cesspool /- New Existing /
Residential Non-Residential •
•
DATE OF PREVIOUS PUMP-OUT: /9'73
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.)
Sign ure of Applicant
RECEIVED BY: dr -CL'
Town Clerk's Office
DATE:
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