HomeMy WebLinkAboutAsher Town Hall, 53095 Main Road
cft ;�,y - �� P.O. Box 1179
® 4°�' Southold, New York 11971
JUDITH T.TERRY
I'0. TELEPHONE
GOWN 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. 899-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ASHER, JOHN H.
Mailing Address 1 200 GEORGE ROAD
Mailing Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Property Address 1 200 GEORGE ROAD
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 516-734-5269
Tax Map No. section 117.00 block 4 lot 16.000
Cross Street FRED STREET
Date Of Last Pump Out 0/00/00
Issue Date: 11/01/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold • CQ Application No. 8-
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
.0 Residential
p. O. Box 1179 cn , a.' r ; Non-Residential
Southold, New York 11971 ff '_
Telephone .( Y►
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. P9. 7
Fee $ 10.00
DATE 1°Psl gg
OWNER NAME: 1-0•14-1.1 JI. 45({-02,
OWNER MAILING ADDRESS: foo 6eogG6 fci0
fJ 9.e) SoFro l-IC v cf 11�j�
OWNER PROPERTY ADDRESS: ;100 fQ &t
N ao £oFFo i.k 111`41 • 1 f'1J
OWNER TELEPHONE NUMBER: 134_ ,I'a,vi
TAX MAP NO. : Section 111 Block ' Lot IG
CROSS STREET: rge-p
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New Existing '✓
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT: AJou
.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.)
% _t,t/
Signature of Applicant
•
RECEIVED BY:
o CI rk ,� ffice
DATE: /// / T -
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