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HomeMy WebLinkAboutBlesch siOC)\1 f 0LI(C® JUDITH T. TERRY ; Town Hall, 53095 Main Road TOWN CLERK g=r P.O. Box 1179 REGISTRAR OF VITAL STATISTICS 1:11 ,• Southold, New York 11971►� MARRIAGE OFFICER O r Fax (516) 765-1823 lt• ►► Telephone (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3110-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner BLESCH, EDWIN J. JR. Mailing Address 1 P. O. BOX 330 Mailing Address 2 City St Zip ORIENT NY 11957-0000 Property Address 1 45 YOUNGS ROAD Property Address 2 City St Zip ORIENT NY 11957-0000 Owner Telephone No. 516-323-3858 Tax Map No. section 18.00 block 1 lot 14.000 Cross Street MAIN ROAD Date Of Last Pump Out 0/00/00 Issue Date: 9/23/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) T. OFFICE OF THE TOWN CLERK cOFUlf( = Town of Southold � 1 CQG Application No. //0 Judith T. Terry, Town Clerk ' Town Hall, 53095 Main Road tf. -< $10.00 - Residential P. O. Box 1179 v' ; $25.00 - Non-Residential Southold, New York 11971 *.$ Telephone O Telephone 1 [ (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /O . e-O DATE e?-7,.,1-779_.3 OWNER NAME: -5-P t#J/N `1'� B LEsC'// OWNER MAILING ADDRESS: P, 0 - 13o?c 3_3 i-ter U-s / OWNER PROPERTY ADDRESS: 6 , / L--/vi--/ AIV, ®/ 9-C7,--0336 OWNER TELEPHONE NUMBER: L 6� TAX MAP NO. : Section lock Lot c CROSS STREET: /1/ft/t// a _0-1;a•-- TYPE OF SYSTEM: Septic Tank " New Existing Cesspool New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT:. • LOCATION MAP: Must be attached hereto before permit may be issued. —SEC-- (Locate building and system; give north arrow and feet of distance, approximately, to building and closest road.) __© L'1°T‹, • • Sign ure of Applicant 7 RECEIVED BY: Town Clerk's Office DATE: RIMED AUG 3 01993 Town Clerk Southok ,4-Arr P-4-0 p erit v - - - \r'O©Y () 0 1-5 1)1( ` ( 1, 7 p.4-7-AL Hk /17)