HomeMy WebLinkAboutBillman -
1911.11-
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tri{� � Town Hall, 53095 Main Road
:� � �� P.O. Box 1179
d b ,.' Southold, New York 11971
JUDITH T.TERRY ,, 0 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. 696-R Residential X Non-Residential
Fee $ 10 . 00 Septic Cesspool X
New Existing X
Name Of Owner BILLMAN, BETTY V.
Mailing Address 1 10850 MAIN ROAD
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 10850 MAIN ROAD
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-2397
Tax Map No. section 31. 00 block 11 lot 12.000
Cross Street TRUMANS PATH
Date Of Last Pump Out 0/00/00
Issue Date: 5/11/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
k
a, VI.41010
OFFI.( OF THE TOWN CLERK �FFO(,(-
~' Town of Southold , A Application No.'Y6
Judith T. Terry, Town Clerk y
Town Hall, 53095 Main Road c 44 ` � R , : l Residential
P. 0. Box 1179 cnVA Fr- ,,. ' 'n Non-Residential
Southold, New York 11971 O ®�
fit'�•
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE //I /9a-OF
OWNER NAME: 13 ,' y V. .8 ) i- L/±11/x,/
OWNER MAILING ADDRESS: / O 5 M0.4--;._
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OWNER PROPERTY ADDRESS: / 0F5-6 AAs;,
OWNER TELEPHONE NUMBER: 5/G' A/7 7 - 2 3 9 7
TAX MAP NO. : Section 3 f Block 1/ Lot / Z
CROSS STREET: Jj ,-,,?'Y► /3
TYPE OF SYSTEM: Septic Tank New Existing V
Cesspool New Existing V
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: /{/Gv4
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.)
f
S'/nature of Applicant (pi
RECEIVED BY: QerX_-ac..
jki• p'erk's 0 ice
DATE:
MAY 11191
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