HomeMy WebLinkAboutBogan -
00
JUDITH T. TERRY O �° Town Hall, 53095 Main Road
TOWN CLERK ` P.O. Box 1179
REGISTRAR OF VITAL STATISTICS *„.. CZ, ; Southold, New York 11971
MARRIAGE OFFICER : � Fax (516) 765-1823
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. 1701-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BOGAN, LAWRENCE AND BERNICE V.
Mailing Address 1 19450 MAIN ROAD
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 19450 MAIN ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5926
Tax Map No. section 115.00 block 7 lot 12.000
Cross Street ELIJAHS LANE
Date Of Last Pump Out 0/00/00
Issue Date: 6/04/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.�� iii
OI FICE OF THE TOWN CLERK S��FO i j
Town of Southold ,,.,- CQ ' Application No. /70
Judith T. Terry, Town Clerk % Ike"ii,, e
Town Hall, 53095 Main Road ,�^ .- I $10.00 - Residential
C!7 f`Y +fit , Al
P. O. Box 1179 4, 7 $25.00 - Non-Residential
Southold, New York 11971 O ® , °' '`
Telephone 1 21 Y► 'o
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE ci )
OWNER NAME: LA t,,,,f.r,oc.,p ; teci.)!C e 1. d p
j
OWNER MAILING ADDRESS: /5 VS-0 (>74 - itte °
1/AZ________________
------ -- OWNER PROPERTY ADDRESS: - ,c Q ____,
OWNER TELEPHONE NUMBER: fle ' :”-^ ,re(
TAX MAP NO. : Section Pg Block 7 Lot JV
CROSS STREET: q I ` L�jtrvc2 o(,v ,Ldc. ( — k,..(..
1 5 •
TYPE OF SYSTEM: Septic ank New Existing
Cesspool New Existing
ResidentialIILL Non-Residential
DATE OF PREVIOUS PUMP-OUT: 7l CI f
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.)
.fit-rAk
: Y - / 4,
Signature of • p.licant
a
0
RECEIVED BY:
Town Clerk's Office
DATE: /--)2 0/� '
A
YOlk
-ro