HomeMy WebLinkAboutAngell 1'�I11�11 a��G
Town Hall, 53095 Main Road
•`: P.O. Box 1179
0," Southold, New York 11971
�2s,'
JUDITH T.TERRY /, '•' TELEFAX PHONE)765-1823
(516)765-1801
TOWN CLERK
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. 1115-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ANGELL, STEPHEN E. AND GAIL F.
Mailing Address 1 1035 THERESA DRIVE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1035 THERESA DRIVE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-3892
Tax Map No. section 115.00 block 15 lot 10.000
Cross Street NEW SUFFOLK AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 5/22/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c,\\FFfl(,�:-
Town of Southold 0 �QG Application No. //`6"-j
Judith T. Terry, Town Clerk y f
Town Hall, 53095 Main Road �s« , -'� Residential
P. O. Box 1179 r.n Non-Residential
Southold, New York 11971 Olag ; 0 �f
Telephone 7
int
(516) 765-1801 1
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 5/t/69
OWNER NAME: SrelahlUi E. MU6-E.)CA—
OWNER
MAILING ADDRESS: /D 1 i #G 5 F 1 .
.*-=7Tvc- , 4y // F34-
OWNER
/ F;4-
OWNER PROPERTY ADDRESS: _a.1?-t-tY
OWNER TELEPHONE NUMBER: 296 " 3 R612-
TAX
612TAX MAP NO. : Section //3—, Oc Block / 5 • 00 Lot 0i0 € 000
CROSS STREET: W-4-3 *t/
TYPE OF SYSTEM: Septic Tank v New Existing
Cesspool New Existing
Residential Non-Residential
�
J�
DATE OF PREVIOUS PUMP-OUT: at '0{' Fei
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.)J
4&-er 1611-e-k
/Signature of I gicant
RECEIVED BY: % _
` - ior n Clerk' /Office
DATE: M.M 22 1989
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