HomeMy WebLinkAboutAsip tt i
ys
_ ds
JUDITH T. TERRY
t', •.�t; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICSa -
- —' Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
• �� - •• - Telephone (516) 765-1801
•�� ,.% j!
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1593-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner ASIP, WILLIAM M. & VIRGINA M.
Mailing Address 1 8255 BRIDGE LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 870 CRITTEN LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-734-5644 -
Tax Map No. section 70.00 block 12 lot 14.000
Cross Street BEACHWOOD LANE
Date Of Last Pump Out 0/00/00
Issue Date: 1/17/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
-aI f,
r i
ttl
to- gi
c1
Q z }
ti
1-5 ,/
19f or&f TI' o F 4//` /f-p std /Mc-dxlargx/4s/r
8-7o C/a awl /1 e
fdein' l-o I/p
7-4X // 70
1 T
•
OFFICE OF THE TOWN CLERK
�
c31FO(�e;•
Town of Southold O� 0 Application No. /5 3
Judith T. Terry, Town Clerk ;:*:i � ►�I
Town Hall, 53095 Main Road =z $10.00 - Residential
P. O. Box 1179 v' * ��`W:1 .
� �, r � �� $25.00 - Non-Residential
Southold, New York 11971 O �
Telephone ,( Atrpt
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE j ).15-7 y (,
OWNER NAME: lTil�/`� �, ]� G'f,#6-G//q- !, ,4-Zr /r
OWNER MAILING ADDRESS: 11-7_,c( ,jj/J� 41--y c
C 6/7/ Ati, //f 3,
OWNER PROPERTY ADDRESS:??i e/f l ys
771-1 /11i It 77
OWNER TELEPHONE NUMBER: 73G/
TAX MAP NO. : Section �G' Block ?/ Lot /7
CROSS STREET: C,k
TYPE OF SYSTEM: Septic Tank New Existing
/
Cesspool !/ New Existing
Residential I/ Non-Residential
DATE OF PREVIOUS PUMP-OUT: /U/7-4/ 9 d
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.)
44/1/42,74A1 .
Signatur o Appli nt
RECEIVED BY:
Eagan Clerk's Office
DATE:
DEC r, _r, la'J goon
iV90
Town Clerk Southold