HomeMy WebLinkAboutCummings ' Judd 0 RI(
JUDITH T. TERRY , Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER
®� � Fax (516) 765-1823
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1888-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner CUMMINGS, MARILYN
Mailing Address 1 P. O. BOX 338
Mailing Address 2
City St Zip LAUREL NY 11948-0000
Property Address 1 WELLS ROAD
Property Address 2
City St Zip LAUREL NY 11948-0000
Owner Telephone No. 516-298-4932
Tax Map No. section 126.00 block 8 lot 3.000
Cross Street ALBO DRIVE
Date Of Last Pump Out 3/00/85
Issue Date: 4/23/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK 'S�FFOLA, - pf�
Town of Southold DSO CG'' Application No. /Pd l
Judith T. Terry, Town Clerk `
n $10:00 - Residential 10
Town Hall, 53095 Main Road
P. 0. Box 1179 c %r � � ; �'
, $25.00 - Non-ResidentW
Southold, New York 11971
Telepho 1
(516) 76.-1801
TOWN OF SI THOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL '
Operation Permit" No.
Fee $ • ,
DATE `4-I0 -cZ
OWNER NAME: YYlflr2 ; v1. u1M W ', n61 S
OWNER MAILING ADDRESS: 6 3 3Z
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-OWNER PROPERTY ADDRESS:
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OWNER TELEPHONE NUMBER: 29 g--"49'3"Z
TAX MAP NO. : Section 1 L Block Q Lot
= CROSS STREET: ICA L3 O .\, V •
,TYPE OF, SYSTEM: Septic Tank New Existing
Cesspool / New Existing ,
Residential ✓ Non-Residential "
DATE OF PREVIOUS PUMP-OUT: 31
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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.)
-77-121 ±4-
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RECEIVED BY: =
Town Clerk's Office ,
DATE:- -
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