HomeMy WebLinkAboutTese i
*OF SO�T'yo
ELIZABETH A.NEVILLE �O l0 Town Hall, 53095 Main Road
TOWN CLERK J J�[ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N ar Southold,New York 11971
MARRIAGE OFFICER • �O� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER D��i Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER COMM southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4279-R Residential x Non-Residential
Fee $ 10.00 New x Existing -
dame 0$ Owner TESE, JOYCE
------------------------------
Mailing Address 1 130 EAST 74TH STREET
------------------------------
Mailing Address 2
City St Zip NEW YORK NY 10021-0000
-------------------- -- ----------
Property Address 1 800 JACKSON STREET
------------------------------
Property Address 2
------------------------------
City St Zip NEW SUFFOLK NY 11956-0000
-------------------- -- ----------
Owner Telephone No. 212-628-1258
------------
Tax Map No. section 117.00 block 10 lot. , 5•.,000
------ --- ------
Cross Street KIMOGENOR POINT
-------------------
------------ ------------
ISSUe
------------------------------=---------------------
Issue Date: 3/14/05 Elizabeth A. Neville
-------- Southold Town clerk
II
(TOWN SEAL)
' o�oSUFFoc�.�,
OG
ELIZABETH A.NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK COD = P.O.Box 1179
REGISTRAR OF VITAL STATISTICS O Southold,New York 11971
MAGEMENT OFFICER RIAGE OFFICERy�0• �0�� Telephone
(631) 765-6145
RECORDS
Jt �► a ephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER 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. Y'Z—7q
Permit No.
Owner Name c
Owner Mailing Address 2J 7� �7F
Owner Property Address CFJ U
p �
Owner Telephone No. ff L (� --�•P�---, ��
Tax Map No: pp Section �� Block ✓0 Lot -5
Cross Streets ILSyy"-0
Please check each that applies: New Construction
Alteration to Existing 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.)
0-
*iatute f Applicant � Date
Received by:
CKSQN Sr
S , R
VINCENT TESE / ^� Sr '?T Op•
S` 800 JACKSON STREET
NEW SUFFOLK
r
7
f o
i
1�
L '
�'� �`�-��- ,,•' � SURVEY FOR
�� i i JO YCE TESE
�a J �� 4 U
ro wN ow sou OL
r �/t
COUNTY,
iA��� E 1" 40
KfA 0:
640- R 25, 1986
I
eo- f A °ter
64r
A.
(ER FIFIED To,
�A
JOYCE )•ESE
Y � ;
A.VYAL17FAATKiN C6 AChNl&. !C :rlf,,YL 4 .70f fAL
LY- cr1T:?C9:•`7)M /•'[N rc OJAtI:fft�A fKh LA•l
t h CYCJ/� YLn
rCA-CA A,9L VALM f,. :r:3 W r h...:.1'h ♦ l(.� r r
+AV HAY CN t f'1.�'3.AI• IhC
to •HOSC �.E LSL1r SC.t �1,�.[ :•L•n.t r�
_`` AI MnY 'AAs YET SIGMA i(IRE-PrCAF••th"YWw
- / Y
N + r-_- / t.j Aa'AFXWAL(Y/('COur'+� .+fh SA10 LAF frn ftl- At ICRLt/n
'9:TG;'.O•�• f /+C/S!A£USCG 6Y ANr.'D AL( c, V[fYg5 V!I I?h(:A CLY•r
p-4M)1}fJ7 A.R�LYOHS NAP f((a Sl.f71 Ia' A/d'1
�r Zoto r Tt*DA 7('ARC NO NC�'�A$4'd[y' frt tAY
-
7 G'QEA T -
P r. 00.
NO. 49618 pECOMC BAq Y
a` AREA-25447 7xxes to tie fne