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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