HomeMy WebLinkAboutBeitrens ELIZABETH A.NEVILLE A� ��: Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER O �� � Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =__ ®l ,,`ssem�,, �4 00. Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER z s �,•1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4015-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner BEITRENS, ARTHUR E.
Mailing Address 1 49 SUNSET LANE
Mailing Address 2
City St Zip CREENPORT NY 11944-0000
Property Address 1 49 SUNSET LANE
Property Address 2
City St Zip CREENPORT NY 11944-0000
Owner Telephone No. 516-477-0527
Tax Map No. section 330.00 block LI lot 55.000
Cross Street SUTTON PLACE
Issue Date: 3/08/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK0� �FFO�,, • Application No 1/o/5
TOWN OF SOUTHOLD �. Gy
ELIZABETH A.NEVILLE,TbWN CLERK $10.00 - Residentia I ✓
P.O.BOX 1179
SOUTHOLD,NSWYORK 11971 $25.00 - Non-Residential
Telephone.( Jig ��0•
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ '
DATE
OWNER NAME:
OWNER MAILING ADDRESS: 'Y9 $ k(S ` kINCE
OWNER PROPERTY ADDRESS: 5 6r-
OWNER
OWNER TELEPHONE NUMBER: 417 542
TAX MAP NO. : Section 33, b ? Block Lot c�
CROSS STREET: Suc 0 rO
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential J/ Non-Residential
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.)
/ I/
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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