HomeMy WebLinkAboutMathers, Allan ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
CA
REGISTRAR OF VITAL STATISTICS v� i Southold,New York 11971
MARRIAGE OFFICER V G �, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `may_'*O j �a��.��, Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER �:�� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4234-R Residential x Non-Residential
Fee $ 10.00 New x Existing
Name Of Owner ALLAN MATHERS
Mailing Address 1 PO BOX 702
Mailing Address 2
City St Zip ROCKY POINT NY 11778-0000
Property Address 1 1245 SLEEPY HOLLOW LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-744-1039
Tax Map No. section 78.00 block 1 lot 10.015
Cross Street ; WILLOW POND LAKE
Issue Date: 1/28/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
gOZ 417
OFFICE OF THE TOWN CLERKIFO
TOWN OF SOUTHOLD �� � �COIj; Application No.
ELIZABETH A.NEVILLE,TOWN CLERK `
$10.00 - Residential ✓
P.O.BOX 1179 • ��
SOUTHOLD,NEW YORK 11971 �,��� $25.00 - Non-12esidential
Telephone • el * /
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION,
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE J I - DWI - 0 3
OWNER NAME: C`\ a Y1_ �'tl1er'S
OWNER MAILING ADDRESS: R 0_ '(3 ('� _ 7® .v _
I11)
OWNER PROPERTY ADDRESS: I a LLS S lee pM H-p Jt (') LAM
Qk.),Aho L at
OWNER TELEPHONE NUMBER: 6 3 _ '7 i CI . r b 3
TAX MAP NO. : Section f Block 0 / Lot
CROSS STREET: tJ M I I 01/4_0 PU n d /G
TYPE OF SYSTEM: Septic Tank / New Existing
Cesspool v New Existing
Residential 1/ 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.)
Ad.
Signature .f Ap: .-nt
•
4)--110L''N
RECEIVED BY:
Town Clerk's Office
DATE: ay
)h7
.
SURVEY OF
LOT 13
rzi
1 _Qf: . ., 1J?- MAP OF
r _� �a -cx, vFj$ SLEEPY HOLLOW
VILE No. 6351 fl FEBRUARY a 1976
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