Loading...
HomeMy WebLinkAboutBenjamin �1i1 tii1� 1.4044.1ytrtA �.� CAV gUr Town Ball, 53095 Main Road \Nr= P.O. Box 1179 �® Southold, New York 11971 7UDITH T.TERRY . FAX(516)765-1823 TELEPHONE(516)765-1801 TOWN CLERK 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. 1431-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner BENJAMIN, BARRY D. Mailing Address 1 P. O. BOX 625 Mailing Address 2 City St Zip - MATTITUCK NY 11952-0000 Property Address-1 MAYFLOWER ROAD Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-5934 Tax Map No. section 107.00 block 8 lot 28.000 Cross Street BROWN ROAD Date Of Last Pump Out 0/00/00 Issue Date: 4/04/90 Judith T. Terry Southold Town Clerk (TOWN SEAL) i' OFFICE OF THE TOWN CLERK FFG Town of Southold 00S .,t.. ea...-- Application No. l LI S Judith T. Terry, Town Clerk % .) Town Hall, 53095 Main Road K $10.00 - Residential P. O. Box 1179 a V.;4-4- • : - :t. ;�, ' . $25.00 - Non-Residential Southold, New York 11971 • -40-44---0,0 i� �0"�• Telephone _ j • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE �� �' OWNER NAME:gPftel 1) . C=1`1 0 • 0 OWNER MAILING ADDRESS., PO . ' %X ( 2T .: ` c I I___,, '1 -\1 . (9S- — OWNER_PROPERTY ADI]RES' : .11.; �� �� ' 9s-9-- • s • OWNER TELEPHONE NUMBER: a(Ag - bq .�- `TAX MAP NO. : Secti 107 Block O Lot a.. CROSS STREET: n d; TYPE O , SYSTEM: - Septic Tank New Existing Cesspool New Existing X Residential X Non-Residential DATE OF PREVIOUS PUMP-OUT: 2 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.) ' ,.:tivii . - ' flOONIA) , el/Wlitr ignature of pplicant RECEIVED BY: __ - ' • Town Clerk's Office DATE: • --I , i, . • ,,.., E A. 5-7T .. „ . , , . . . 1 . .. , . . , • . . .. , 1 - . • . . . 1 , . ... • _ , , ..,.... , , . . , . ,..; 1 7.......--. 1 OO 62151 . - . . , - . , • • ,,..„ . . • , . , . . . i . CE SSPOOL . .....—........._. 4.2 ___ ,„,. . • . , • 1 , .- .• : . , • '• , ,?,.. ' .. . . .. , . • . (• • ... . , . . . . , . . . , 50 I.,/ . , . . . , , ‘: •, ; . . . . . . . . . . . . , . . • . . . • . 1 , . . . .- . , . ,, .. . . _ , . . . . . . . . . . . . ,, . ,... ) N . . .. . . • .5 5... , . . -, . _ .. . .: . . , . . .. . . . . • . I so , Z . . .. . . . . , . . . , . . . . , . . , . . . . . ...,.... . . , ,„ ... . .. . • , . , '• ,''',.,..f." '' . . . . . . . _ I•.; i....“` . , . r . . . , r iHousE. ... 0411 • Z3 „ , :-.....e,..„ 6.... ... . „ . . .. . o . . , . , • . • .. . . - . ...... , , . . • . . . , . . • . , e. . , . . . • . 0 . i .. , . . . . I , lib , . • 'I., , . , . - . - . I . . ' . . , . . . ''b B - . • . , ..., . . _ . . • i . ,....- . . . • •• 50 • . c..... . . . , , • .. , • ,,, ., . , . , ,• . . • .. , . • , , • - ., . . , ,. .. . . . , • . , . , r . ? . • ' . . , , . .. . ••• .._ . • . •. ......,.., . . .. . , . . , , . . . . . . . . ,, • , .. • . • . . .. . , •,., .•.; _.•, ... • • .1. 4,..... . , • -. .. 4. • . , . . . • , ,, , 1\/1AYV.7..Lo\/J.E_R • . , , . , '•-•..,, , . . . , • . , - - ,';',r•If.: .. ' ' , . , . . , . , . , . , - ; ?,