HomeMy WebLinkAboutAlec o A
urt Town Hall, 53095 Main Road
to 0 �i�, P.O. Box 1179
-_; j�
4,° Southold, New York 11971
JUDITH T.TERRY 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. 1287-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ALEC, GEORGE
Mailing Address 1 MAIN ROAD
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-6121
Tax Map No. section 109.00 block 1 lot 7.000
Cross Street ELIJAHS LANE AND ALVAHS LANE
Date Of Last Pump Out 0/00/00
Issue Date: 10/30/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
C/
OFFICE OF THE TOWN CLERK c�vFFaii/'-
Town of Southold _C� Application No. /J-41-7Yy -1
Judith T. Terry, Town Clerk . t f a :'
Town Hall, 53095 Main Road a -< $10.00 - Residential
P. O. Box 1179 v'Q ® 11;4,7:;,«r;� ., 'fl $25.00 - Non-Residential
Southold, New York 11971 `
°
Telephone �j lt 1• ►'�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for -- ..
OPERATION PERMIT
SEPTIC TANK or CESSPOOL -�
Operation Permit No.
Fee $
DATE it9ip,r
OWNER NAME: ,�,,✓�
OWNER MAILING ADZ: 41 /
Af/t>) / tP/ 9
OWNER TELEPHONE NUMBER: 7 5 119 --- A
TAX MAP NO. : Section /2 7 Block / Lot 7
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing ��
Residential k Non-Residential
DATE OF PREVIOUSPUMP-OUT: % ;1';10
LOCATION MAP: Must be attached hereto b-:ore permit may be issued.
(Locate; building and system; give north arrow and feet
of distance., approximately, to building and closest road.)
`r
it ture o pplicant
RECEIVED BY:
,4o„aha Clerk's Office
DATE: OCT 3 01989
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