HomeMy WebLinkAboutAxelson cpt 4y,
' Town Hall, 53095 Main Road
*r ee* P.O. Box 1179
���s Southold, New York 11971
JUDITH T.TERRY - „'//ii ��� FAX(516)765-1823
TOWN CLERK TELEPHONE(516)7654801
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. 1225-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner AXELSON, KARL AND JANINA
Mailing Address 1 P. O. BOX 956
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1505 VILLAGE LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5866
Tax Map No. section 107.00 block 11 lot 4.000
Cross Street ROUTE 25
Date Of Last Pump Out 0/00/00
Issue Date: 8/25/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
I
OFFII II -
CE OF THE TOWN CLERK " •5 �F0(;„-'-
Town of Southold % ,_. CzApplication No. /,D9_S-
,
T. Terry, Town Clerk % ,`fi. ,-f%
Town Hall, 53095 Main Road ` "'''iS r .G 1 $10.00 - Residential
P. 0. Box 1179 . ';, .r:
tri �n�-�•_:� �K�`=^��'� � Z $25.00 - Non-Residential
Southold, New York 11971 - 0�'Cr, �$
Telephone Q( '* `��� .••
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE j- S— 8'9
'OWNER NAME: eNRj, 1 ,1 AN 11413 Al(O,LS o,kl
OWNER MAILING ADDRESS: 2d. , e,X ?,S'.Z
rip A TT/`T v tx Atli //9sr
OWNER PROPERTY ADDRESS: ZSO-S"•'s V1' C,E-._ 44.49AsE_
•
MA V"'7;).7 uair._ py. //9 V'L.,
OWNER TELEPHONE NUMBER: ...?rd/- ^ Z.4
TAX MAP NO. : Section /07 Block // Lot I
CROSS STREET: g001-0 R5.-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing X
Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: l'e` 2 ErY
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.)
Si natu of Applicant
RECEIVED BY: .U/A"'"(
own Clerk's Office
DATE: d-1-- / r,
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