HomeMy WebLinkAboutChase ! Town Hall, 53095 Main Road
�'® P.O. Box 1179
®1 0 I.00Southold, New York 11971
JUDITH T.TERRY r 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. 660-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner CHASE, STANLEY
Mailing Address 1 116 CENTRE ISLAND ROAD
Mailing Address 2
City St Zip OYSTER BAY NY 11771-0000
Property Address 1 515 SOUTH DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-922-2900
Tax Map No. section 106. 00 block 11 lot 21. 000
Cross Street BAYVIEW AVENUE
Date Of Last Pump Out 0/00/00
.7- /
Issue Date: 3/28/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
&d.
OFFICE QF-"THE TOWN CLERK Mire,
Town of Southold Application No.40
0
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road '. .G Residential c---""
P. O. Box 1179 51 �� i
�� Non-Residential
Southold, New York 11971 O�i �O�
Telephone .(_M '/���`
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 2-17-88
OWNER NAME: Stanley Chase
OWNER MAILING ADDRESS: 116 Centre Island Road
Oyster Bay, N Y 11771 •
OWNER PROPERTY ADDRESS: 515 South Drive
Mattituck, N Y 11952
OWNER TELEPHONE NUMBER: 516:922-2900
TAX MAP NO. : Section 106. Block 11 Lot 21
CROSS STREET:
TYPE OF SYSTEM: Septic Tank . X New Existing
Cesspool X New Existing
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: ' UNKNOWN
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.)
/(44-6u7-(-
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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