HomeMy WebLinkAboutBrant JUDITH T. TERRY y Town Hall, 53095 Main Road
TOWN CLERK -a'? "1 "✓~ P O. Box 1 179
REGISTRAR OF VITAL STATISTICS ° ' Southold, New York 11971
MARRIAGE OFFICER `'- ` Fax (516) 765-1823
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(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1585-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New Existing X
Name Of Owner BRANT, WILLIAM AND MARIAN
Mailing Address 1 80 OLE JULE LANE
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 80 OLE JULE LAN E
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-5456
Tax Map No. section 114.00 block 12 lot 18.000
Cross Street NEW SUFFOLK AVENUE
Date Of Last Pump Out 0/00/00
Issue Date: 1/17/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �C��FFU
Town of Southold � '- Application No. /.3R5
Judith T. Terry, Town Clerk 5 �
Town Hall, 53095 Main Road a A „z 4 $10.00 - Residential
P. O. Box 1179 v' `' x `%� •
� � .:,�aa•;�' $25.00 - Non-Residential
`'®
Southold, New York 11971 O f ��J
Telephone _01 .
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for-
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /D Qe
DATE "I��` D
OWNER NAME: V1%`�.kQM At, �wq,,,,‘.01.4 "a,c,,,iebr 07 •
•
OWNER MAILING ADDRESS: $b ®�� Sod.* SANE
OWNER- PROPERTY ADDRESS: ��t���•
OWNER TELEPHONE NUMBER: •�cy$ -505%
TAX MAP NO. : Section W1/4 Block ��„ Lot
CROSS STREET: yaT�‘,. SVsvvot ..�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential f Non-Residential
DATE OF PREVIOUS PUMP-OUT: a,,4.1"k•-•
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.)
‘614 `.449‘s,
ign�a�of Applicant
RECEIVED BY: ,
Tow ' Cle'rk'' Office
DATE:
NOV 2 v 1990
Tzu 4eter{ South*
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