HomeMy WebLinkAboutAlbertson / F9pgpp''.
Town Hall, 53095 Main Road
P.O. Box 1179
•��� Southold, New York 11971
JUDITH T.TERRY
- _ �� ��� 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. 728-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner ALBERTSON, ALBERT W. JR.
Mailing Address 1 KATZ, DONALD
Mailing Address 2 MAIN STREET
City St Zip SAG HARBOR NY 11963-0000
Property Address 1 700 CRITTENS LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-725-0145
Tax Map No. section 70.00 block 12 lot 12. 000
Cross Street PARKWAY ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/08/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c.31FO(,r
Town of Southold pis. ': � �t Application No.
Judith T. Terry, Town Clerk g •
Town Hall, 53095 Main Road o = '� Residential
P. 0. Box 1179 v' `` Non-Residential
Southold, New York 11971 O ® •'a' •
Telephoneto
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ j0. U-0
DATE 4/7/Pe
OWNER NAME: �0tiiiW Kr 1 lbE1M,I U1 pL13EJ s'J .IP
OWNER MAILING ADDRESS: ✓T1.gsti, AZ •
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1-1.4A-6-11
�J• '11 . ///t3
OWNER PROPERTY ADDRESS: r 100 Litt,„, .
/J. 14 . i 1'•-H b
OWNER TELEPHONE NUMBER: 5/4 -• '72,5— 0/45
TAX MAP NO. : Section 7,® Block /� Lot /a
CROSS STREET: cu,,�,�`'��` •
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing /
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: 3)/1 J
LOCATION MAP: Must be attached hereto before permit may be issukd.
• (Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
3_,uu
v- e ��
Signature of'Applic if
RECEIVED BY
Town% lerk's/'Office
REM'./`: :*"
DATE:
AM 08 19
Town Clerk Southold
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