HomeMy WebLinkAboutBordsen ELIZABETH A. NEVILLE 11,� �� Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
S Southold, New York 11971
MARRIAGE OFFICER : 1/ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �;_ ,ss22,, $4` 0111 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `Ls' ���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4018-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner BORDSEN, KELLY & CHARLES
Mailing Address 1 P 0 BOX 1741
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 235 LLOYD'S LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 631-298-1227
Tax Map No. section 99.00 block 3 lot 4.009
Cross Street SOUND VIEW DRIVE
Issue Date: 5/12/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
öFF10E OF THE TOWN CLERK C Fait' Application No. 17161/.
TOWN OF SOUTHOLD &,% G
ELIZABETH A.NEVII.I.F,TOWN CLERK $10.00 - Residential /
P.O.BOX 1179 8
tri $25.00 - Non-Residential
SOUTHOLD,NEW YORK 11971 *.$
- Telephone _ .! * , 0'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. a o (0 3 s?
Fee $ l l3 .8D
DATE 31 13 ) Zia
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OWNER NAME: {����A (t. L✓Victrti9d R yct -
OWNER MAILING ADDRESS: 'PD 130 c 1-1 y 1
rn t � i IIgsa
OWNER PROPERTY ADDRESS: �'� s 1 I c� �. ��� I auzQ
Yin P u 1 1 cs s d,
OWNER TELEPHONE NUMBER: S t (p a') $ - i a-ai /
TAX MAP NO. : Section q v7 C) Block 3 Lot 4.609
CROSS STREET: ti_tb b-Qia.Q,
TYPE OF SYSTEM: Septic Tank New / Existing
Cesspool New f Existing
Residential 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.)
'1 /ice
Signature o' Applicant r
RECEIVED BY:
Town Clerk's Office
DATE:
r• ,.a ,/�/iii---
OFFOLsr
ELIZABETH A.NEVILLE �`�` � Town Hall, 53095 Main Road
TOWN CLERK
�� � P.O. Box 1179
® ,.,
Southold, New York 11971
.:
REGISTRAR OF VITAL STATISTICS .a. 7 ;
MARRIAGE OFFICER `® �r� e, // Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER �' Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER (41 B 'Vote.
•0�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2063 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SOUND DESIGN HOMES INC
Address 1 : PO BOX 605
City St Zip CALVERTON NY 11933
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-99-0056
Name Of Owner SOUND DESIGN HOMES INC
Mailing Address 1 PO BOX 605
City St Zip CALVERTON NY 11933
Property Address 1 LLYODS LANE - LOT #8
City St Zip MATTITUCK NY 11952
Tax Map No. section 99.00 block 3 lot 4.008
Cross Street SOUND VIEW DRIVE
Building Permit Number Cross Reference:
a •
Issue Date: 5/05/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)