HomeMy WebLinkAboutAvent JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER � ®� � Fax (516) 765-1823
— „ � .0 Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2018-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner AVENT, CARL AND LAURA
Mailing Address 1 P. O. BOX 149
Mailing Address 2
City St Zip NEW SUFFOLK NY 11956-0149
Property Address 1 875 KING STREET
Property Address 2
City St Zip NEW SUFFOLK NY 11956-0149
Owner Telephone No. 516-734-5963
Tax Map No. section 117.00 block 7 lot 26.000
Cross Street FIRST STREET
Date Of Last Pump Out 0/00/00
Issue Date: 12/08/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK •c� F�U(
Town of Southold % �FCQ Application No. o)
Judith T. Terry, Town Clerk ,, w •I $10.00 - Residential
Town Hall, 53095 Main Road c
P. 0. Box 1179 cry r- �'` . - $25.00 - Non-Residential
Southold, New York 11971 O ® tbn ,'`
Telephone 4e ,
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- __ - - -
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. c21. Jc'
Fee $ 10,00
DATE bol/63/Qa
OWNER NAME: CR RL- S. el LAU R4 M. Ave IVT
OWNER MAILING ADDRESS: P.O . BOX I'-
I ) w soCFoLK, 13Y I1g56-ol4q
- OWNER PROPERTY ADDRESS87c KIoG 45T.
N&w suFFOLt , try tia•56roici9
OWNER TELEPHONE NUMBER: 7341-590
TAX MAP NO. : Section 117 Block 07 Lot a (c
CROSS STREET: rias-t'
TYPE OF SYSTEM: Septic Tank New Existing ✓
' r
Cesspool New Existing
Residential ✓ Non-Residential
DATE OF PREVIOUS PUMP-OUT: `}m-lv. t q�
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.)
ff YY
Signature of Applicant
'
RECEIVED BY:
•wn Cler 's Office
DATE: RECEIVED
DEC 08 11992
Southold Town Clerk
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