HomeMy WebLinkAboutCrescent Beach Condo ���.
Town Hall, 53095 Main Road
P.O. Box 1179
� .0 Southold, New York 11971
JUDITH T.TERRY I•••i TELEPHONE
TOWN CLERK /��oJ ,(516) 765-1801
REGISTRAR 01 VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 913-R Residential X Non-Residential
Fee $ 10 . 00 Septic Cesspool X
New Existing X
Name Of Owner CRESCENT BEACH CONDO . ASSOC.
Mailing Address 1 P . 0 . BOX 542
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 MAPLE LANE
Property Address 2 UNITS. 13 & 14
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-9852
Tax Map No. section 38. 1. 01 block 1 lot 13 . 000
Cross Street CROSS ROAD
Date Of Last Pump Out 0/00/00
Issue Date : 11 /09/88 Judith T . Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 'c�vFD(,'� 9/a'
Town of Southold Off% � ;h ti C'0�- Application No. �/ .
Judith T. Terry, Town Clerk y
Town Hall, 53095 Main Road .t`,, .,r , -< , Residential
P. O. Box 1179 i hWiti �, Non-Residential
Southold, New York 11971 O ® �
Telephone �( ' `�,O..•
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ Vic, a 0
DATE //,-)/G hi
OWNER NAME: c/ /7 / - ,/ Cc/til S 0 < ,4
OWNER MAILING ADDRESS: Zo. /caV'f� - (fil9t/4...,_ Ljt-iL/SG � �/ ',e--,�v)'
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OWNER PROPERTY ADDRESS: r/4L-i-,� .
OWNER TELEPHONE NUMBER: 74— X77 _9 rV 2 Ccoi.✓ .d'ofx •
TAX MAP NO. : Section 3 k° ! Block / Lot i
/3LIc�
CROSS STREET: /`'/ ,� L /.� C, ,,f,/- X-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool „,-7 New 0 Existing
Residential 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.)
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Sig " e -CIApplicant
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RECEIVED BY: S+.y,A e0l /7/,./,71-- ,4z'✓�
Town Clerk's Office
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