HomeMy WebLinkAboutBanick oilFaiber
JUDITH T.TERRY � `�• `
Town Hall, 53095 Main Road
TOWN CLERK ` ! ": P.O. Box 1179
@stOt Southold,New York 11971
ftEGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER L 44 -49 �g Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER = 1� l''';•111� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,,is"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3741-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner BANICK, AGNES PEGGIE
Mailing Address 1 P. O. BOX 834
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 1440 FOUNDES PATH
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-3231
Tax Map No. section 64.00 block 4 lot 8.000
Cross Street LANDON LANE
Issue Date: 12/09/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
410
OFFICE OF THE TOWN CLERK 274/1
Judith
Town of Southold
, 0� ��OGt;, Application No. 27
Judith T. Terry, Town Clerk ';
• Town Hall, 53095 Main Road -'� $10.00 - Residential
P. O. Box 1179 'r; `ti. i ;' $25.00 - Non-Residential
Southold, New York 11971 O ®
Telephone ®( Ay( 0 "
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /O-DD
DATE - (' 8'- q 7
OWNER NAME: fign e P-e 9' g/ f� ,Bct.�/e/K
OWNER MAILING ADDRESS: p, �3/7 "z4/0 Foc r?cfe`s PaM
So c7- -Gro Ir( L) 9) 7/97 /
OWNER PROPERTY ADDRESS: /'/[Q Pd C1/'e-r'S Az_t-A
c z. --ko Lc(' /U S' // _9 7/
OWNER TELEPHONE NUMBER: 7kS---3a3 /
e,3 7 /OP) Sex-z-rS e, Witt f-eh e a_e.P 477- S-732_
TAX MAP NO. : Section (n Lf 6) Block / Lot 6
CROSS STREET: A ez-t?ctp ane.
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool_ !/ New— Existing,
Residential � Non-Residential
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.)
-� / 2 1/
, ,
Signatu/eefof Ap.licant
404 2 e. , / , , („;%:o./4_)
RECEIVED BY: � 6
ownCler 's Office
DATE: DEG " 1997
South Id TOUVil C 1