HomeMy WebLinkAboutCribbin JUDITH T.TERRY �� yd Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
Too $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER %A - �1�/ Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER -: ®1 '������ Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3502-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner CRIBBIN, THOMAS
Mailing Address 1 P. O. BOX 285
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 175 2ND STREET
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-4250
Tax Map No. section 126.00 block 10 lot 2.000
Cross Street BRAY AVENUE
Issue Date: 8/16/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• ���
OFFICE OF THE TOWN CLERK ••
oS�WFo�0,2%,.\ �3s o02
Town of Southold � • Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ,} '1,{ , "1,r3a .0 ) $10.00 - Residential��_____
P. O. Box 1179U' s `r .; t ' `}`
' $25.00 - Non-Residential
Southold, New York 11971
Telephone = ( y1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE Y -Ayp6
OWNER NAME: IN1s1R n MAS CA2A- 1010'.%
OWNER MAILING ADDRESS: ? v `D SSZ
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OWNER PROPERTY ADDRESS : T S! aril) s rzcet
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OWNER TELEPHONE NUMBER: j' '" 4/(26-0
TAX MAP NO. : Section / Q G a 00 Block /0 ,,, d0 Lot O 0' ' 0 0 0
CROSS STREET: f-BR.t AUQ
TYPE OF SYSTEM: Septic Tank NewExisting
Cesspool New Existing X
Residential Non-Residential
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.)
/1/17J
°Signature of Appl' ant
RECEIVED BY:
Town Clerk's Office
DATE:
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