HomeMy WebLinkAboutCrawford (2) Mil
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Town Hall, 53095 Main Road
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� ii- P.O. Box 1179
-�_ e 410 Southold, New York 11971
JUDITH T.TERRY 3��„ is � 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. 1368-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CRAWFORD, DOROTHY K.
Mailing Address 1 3 HILLCREST DRIVE
Mailing Address 2
City St Zip RANDOLPH NJ 07869-0000
Property Address 1 620 AQUAVIEW ROAD
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 201-366-0711
Tax Map No. section 21 .00 block 3 lot 9.000
Cross Street ROCKY POINT ROAD
Date Of Last Pump Out 0/00/00-
Issue Date: 1/11/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.
OFFICE OF THE TOWN CLERK oSFO(,r�'
Town of Southold Q C�G� Application No. /3��/
Judith T. Terry, Town Clerk y
$10.00 - Residential
Town Hall, 53095 Main Road
P. O. Box 1179 v' t-k4 pry'^ ` •
� • $25.00 - Non-Residential
Southold, New York 11971 O Y ":_�:37.0-1"
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Telephone a/ Iff< 'NG; '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 1 / 4q�
OWNER NAME: mRS, ���o� t�� ', GR / 1AJ1=•oPz-
OWNER MAILING ADDRESS: :3 1-4' c e cr ap2 o Ir&
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OWNER PROPERTY ADDRESS: _. rjki1,`®la� _ - - _
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OWNER TELEPHONE NUMBER: ( F) 3667--a��ti
TAX MAP NO. : Section a ( Block 3 Lot
CROSS STREET: Rbc,«y pot &)T' PZoft-L
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New, Existing X
Residential \K Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
i , , 1 '\ , (119" l�
Signiure of Applica
RECEIVED BY:
Town Clerk's Office
DATE:
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