HomeMy WebLinkAboutBiggs (3) 1
I Town Hall, 53095 Main Road
‘,196C, ti.,4 P.O. Box 1179
_ SI V!I�; Southold, New York 11971
JUDITH T.TERRY FAX FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 1184-R Residential X Non-Residential
" Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BIGGS, THERESA
Mailing Address 1 208 KNAPP PLACE
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 208 KNAPP PLACE
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-0379
Tax Map No. section 34.00 block 2 lot 9.000
Cross Street BAILEY AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 7/06/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ' i i g
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Town of Southold s '. ..,-4--
`,QG': Application No.
Judith T. Terry, Town Clerk ta-� gTown Hall, 53095 Main Roada0 ' '`'< Residential
P. O. Box 1179 T " z Non-Residential
Southold, New York 11971 O ®2 O*�'
Telephone 414 Y►t 'e
(516) 765-1801
TOWN OF SOUTHOLD
1
SOUTHOLD WASTEWATER DISPOSAL DISTRICT 4,,'"
r
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
/J
Fee $ / DATEy/y9
OWNER NAME:, G 2 e. .S at- 1310 'S
OWNER MAILING ADDRESS: c721) 8- k N Pp Pko e.
c4-� Po ,€T 1Y y ,'/y9/
OWNER PROPERTY ADDRESS: c.5/9 1/7 --
OWN, R T LEPHONE NUMBER: tVG - //7"71-• 03 7 9'
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p AX MAP NO. : Section i2, Block Lot
I i CROSS STREET: A. _
61 i
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool K New Existing '`
, Residential X Non-Residential
DATE OF PREVIOUS PUMP-OUT: .,e.i /74
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.)
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Signature
of Applicant ,/ 2.
RECEIVED BY:
Town Clerk's Office
DATE:
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