HomeMy WebLinkAboutBaker (2) 5_
116
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.rr �. Town Hall, 53095 Main Road
t. � � ���� P.O. Box 1179
'W'����o Southold, New York 11971
JUDITH T.TERRYi/�r. TELEPHONE
TOWN 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. 726-R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
New Existing X
Name Of Owner BAKER, VINA
Mailing Address 1 455 FDR DRIVE
Mailing Address 2
City St Zip NEW YORK NY 10002-0000
Property Address 1 WICKHAM AVENUE
Property Address 2 HOUSE #1
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 139 . 00 block 2 lot 5. 000
Cross Street BAYER ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/06/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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Town Hall, 53095 Main Road
a P.O. Box 1179
1 .��� Southold, New York 11971
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JUDITH T.TERRY �, , �►� TELEPHONE
TOWN 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. 727-R Residential X Non-Residential
Fee $ 10 . 00 Septic Cesspool X
New Existing X
Name Of Owner BAKER, VINA
Mailing Address 1 455 FDR DRIVE
Mailing Address 2
City St Zip NEW YORK NY 10002-0000
Property Address 1 WICKHAM AVENUE
Property Address 2 HOUSE #2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 139. 00 block 2 lot 5.000
Cross Street BAYER ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 6/06/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ,,I �C�[J�
Town of Southold SDG' , Application No. -702(i _
Judith T. Terry, Town Clerk .**1,0 4�
Town Hall, 53095 Main Road �' `'� ` Residential f
P. O. Box 1179 ct- art ; Non-Residential
Southold, New York 11971
Telephone J?141 ' ..'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. -74 (p -7a-7
Fee $ .00
DATE 6 -6
OWNER NAME: Vina Baker
OWNER MAILING ADDRESS: 455 FDR Dr.
New York, NY 10002
OWNER PROPERTY ADDRESS: Wickham Avenue 611,6t-(2424.40-- CL€�,C
Mattituck, New York 11952 J
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 139 Block 2 Lot 5
CROSS STREET: BRyk R poab
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool X New Existing X
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: _-------
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.)
Signature of Applicant
RECEIVED BY: c ,/
Town (Clerk's 0 ice
DATE:
c„ *_.
OFFICE OF THE TOWN CLERK OF
' Town of SoutholdOlj
Judith T. Terry, Town Clerk .`�O
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971 Ol •S
Telephone Al A g[ ' ,,/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. Residential
Fee $ ,
--/ Non-Residential
Septic Cesspool
PERMIT ISSUED TO:S
NAME: 4 -is At--A-e --
ADDRESS:
, # 6-.; 7--,(Z' 11 1 bi •4/ • i,L (-
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
LOCATION OF PROPOSED CONSTR CTION or ALTERATION:
OWNER OF PROPERTY: /WWI-,
OWNER MAILING' ADDRESS: ra5,/,
� , `� " °°
2...__
OWNER PROPERTY ADDRESS :
TAX MAP NO. : Section Block Lot
CROSS STREET:
. BUILDING PERMIT NUMBER CROSS REFERENCE: - - - • -
Judith T. Terry
Southold Town Clerk
DATE: .1/
' '2--
!1
(TOWN SEAL)