HomeMy WebLinkAboutChaloner Y� papJA.{
Town Hall, 53095 Main Road
�'"'''�`'1 s : P.O. Box 1179
=::5949 r i''O O Southold, New York 11971
JUDITH T.TERRY ' FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1519-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CHALONER, JOHN J.
Mailing Address 1 P. O. BOX 249
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 865 NEW SUFFOLK LANE
Property Address 2 (PROUD HOUSE)
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-7447
Tax Map No. section 109.00 block 7 lot 3.000
Cross Street MAIN ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 8/13/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK
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Town of Southold ` F�(�
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' Application No. /5/?
Judith T. Terry, Town Clerks
Town Hall, 53095 Main Road - -< $10.00 - Residential
p. O. Box 1179 cry �z. '..,; $25.00 - Non-Residential
Southold, New York 11971 O
Telephone :*I'
41
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Operation Permit No. 1 579
Fee $ /b.
DATEAvt.s-f- /f q o
'OWNER NAME: C awl J . OkaitOOr •
•
OWNER MAILING ADDRESS: PD • r y ;2zf
aci-otol -e. Ny . _
OWNER PROPERTY ADDRESS: • I c-a'
Nas- A/6w a ka-fxL, 0 , 0 /14/163-c
OWNER TELEPHONE NUMBER: 51(p 734/- 747`
TAX MAP NO. : Section /0 7 Block 7 Lot 3
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: /-PPP-0x dW,y Ic'cr1y
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.)
/
ignature of Applicant
RECEIVED BY: o Town r(-11-49
lerks ffice
DATE:
AUG13 1990
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