HomeMy WebLinkAboutAxberg , . Town Hall, 53095 Main Road
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W P.O. Box 1179
0�"�' Southold, New York 11971
JUDITH T.TERRY -_ �, TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OE VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 858-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner AXBERG. ARTHUR H. JR.
Mailing Address 1 1 DELAWARE RIM DRIVE
Mailing Address 2
City St Zip YARDLEY PA 19067-0000
Property Address 1 CAMP MINEOLA ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 215-493-1539
Tax Map No. section 123 . 00 block 5 lot 34. 000
Cross Street CAMP MINEOLA EAST EXT
Date Of Last Pump Out 0/00/00
Issue Date: 9/26/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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I
OFFICE OF THE TOWN CLERK cOFOC,t '•
Town of SoutholdCQG',, Application No.
Judith T. Terry, Town Clerk .P i,11;
Town Hall, 53095 Main Road 04:
` Residential
tris � -- �� . .'
P. 0. Box 1179 :,r = ,� . Non-Residential
Southold, New York 11971 O ® `._; 0� •1
Telephone .( w�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVED APPLICATION
S',::1) 1 6 988 for
TOW Cloth Southold
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /69,90
• DATE /
OWNER ,
OWNER MAILING ADDRESS: I D ettuvQ.eyeR t 1 e",
eird1e), Pte_. /9® ,��
OWNER PROPERTY ADDRESS: Q.
OWNER TELEPHONE NUMBER: . P r Y ? 3 /f Z ?
TAX MAP NO. : Section a's3 Block Lot ,5
CROSS STREET: C -p [nJ--eG c_(- EA-S r
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool � New Existing \l"
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: \ 3
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.)
x / Signatu of Aicant
nciL
RECEIVED BY:
RECO' r
own Clerk's Office
DATE:
SEP 2 6 Se
Town Cloth g®,
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