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HomeMy WebLinkAboutCorey 04 ' cOf _- ' ® ® r '14-klra'r}s9' Town Hall, 53095 Main Road �� P.O. Box 1179 — �� ����� Southold, New York 11971 Ellfi JUDITH T.TERRY 1/g� 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. 732-R Residential X Non-Residential Fee $ 10. 00 Septic Cesspool X New X Existing Name Of Owner COREY, ROSCOE C. Mailing Address 1 COREY, MARJORIE L. Mailing Address 2 P.O. BOX 1698 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 830 CLEARVIEW ROAD Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-5213 Tax Map No. section 89. 00 block 3 lot 11. 001 //, U 0-6- Cross Street MAIN BAYVIEW ROAD Date Of Last Pump Out 0/00/00 Issue Date: 6/13/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) OFFICE OF THE TOWN CLERK CXWFU(���= C>,14__)f'"--- Judith of Southold ��� QG Application N. Judith T. Terry, Town Clerk . � o / Town Hall, 53095 Main Road " 1 Residential C/ P. 0. Box 1179 to " ' Non-Residential Southold, New York 11971 f Telephone (516) . 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION icor - OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. ,1 ,s-Lf Fee $ I0 .4U DATE 1-9. OWNER NAME: ROSCOe. c 4 Al 01'3;14 e, L OWNER MAILING ADDRESS: lJ / f6,9T '_ u L4, A 1/971 OWNER PROPERTY ADDRESS: `?,() ,tulR n l � OWNER TELEPHONE NUMBER: `/ (� cm 1 3 TAX MAP NO. : Section , Gf Block 3 Lot 60 CROSS STREET: � 14/ /11J�/ Ure�e/ .,,e4 TYPE OF SYSTEM: Septic Tank New Existing Cesspool X. New ri Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: y/ 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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