HomeMy WebLinkAboutSpeyer SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4371-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner SPEYER, JAMES & KAREN
Mailing Address 1 450 WEST END AVE., APT 3A
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Mailing Address 2
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City St Zip NEW YORK NY 10024-0000
Property Address 1 2100 JACKSON STREET
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Property Address 2
City St Zip NEW SUFFOLK NY 11956-0000
Owner Telephone No. 212-873-6827
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Tax Map No. section 117.00 block 10 lot 18.001
Cross Street FOURTH STREET
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Issue Date: 3/10/08 Elizabeth A. Neville
` -------- Southold Town Clerk
(TOWN SEAL)
► S%3 F91
RLIZABETH A. NEVILLE h`t Gy Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
Go Z Southold, New York 11971
RE ISTRAR OF VITAL STATISTICS I
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER O'� �a southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 or Non-Residential @$25 Application No.
Permit No. �� L
Owner Name ����^ /`1� ✓C�
Owner Mailing Address �0Q r eWr4'(/��(//UZ�� . "ICE
Owner Property Address '2 f on 861k.&Tay Sr,
Owner Telephone No. F73 6
Tax Map No: Section �� Block Lot 41
Cross Street &_Z__Z_
Please check each that applies: New Construction
Alteration to Exlst' System
Residential ✓ Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
01V Si e of Applicant Date
Received by:
JACKSON STY
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