HomeMy WebLinkAboutArnstein 't/I1I�r/U,1p�,i/,3_� y��a
JUDITH T. TERRY F Town Hall, 53095 Main Road
TOWN CLERK �$
P.O. Box 1179
( ��'
REGISTRAR OF VITAL STATISTICS N �-� Southold, New York 11971
MARRIAGE OFFICER � ® �'.� Fax (516) 765-1823
,4® �4®% . 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. 1910-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ARNSTEIN, JOAN
Mailing Address 1 10 DOWNING STREET
Mailing Address 2
City St Zip NEW YORK NY 10014-0000
Property Address 1 680 LOCUST LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-4176
Tax Map No. section 64.00 block 2 lot 54.000
Cross Street L'HOMMEDIEU
Date Of Last Pump Out 0/00/00
Issue Date: 5/26/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
III
OFFICE OF THE TOWN CLERK \c,\FFO(,r�'-
Town of Southold
�'�l'� Application No. f�
4u�ii.iii T. Terry, Town Clerk ` " y
Town Hall, 53095 Main Road 8 �~ $10.00 - Residential X
P. O. Box 1179 u-3 = ' ,y $25.00 - Non-Residential
Southold, New York 11971 . 0 �dil1.� R' _\-- ••
Telephonelit i
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
— -- = = for _ _ _ -- __, _ __
OPERATION
_-
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ to:00
DATE c`o....k et 2_
OWNER NAME: "To 0...,-,. Pc,r -e...;„
OWNER MAILING ADDRESS: to Vo�,,,,-1; ,r; 'j-k-„-ee-lc
'Nem `(v.Ak� `e• too t'-'t
OWNER PROPERTY ADDRESS: t,,�o y.,,o�",,5�- 1--ck,,,-,�„
50,,,„kt^o1d1 om.`►'_ 1tSll
OWNER TELEPHONE NUMBER: --11/4,95- ►-E't--Il4,
TAX MAP NO. : Section Cl Block o-- Lot ��J/
CROSS STREET: ( � _ /
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing .'G
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: Z
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.)
ignature of Applicant
RECEIVED BY: , (YU,Aj -- ,
/ Town Clerk's Office
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