HomeMy WebLinkAboutCarpenter, Patrick SUFFO1,�cO
ELIZABETH A.NEVILLE �� h� Gy Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER �, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `'._ -4 ifi �a�l��,, 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. 4225-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name of Owner CARPENTER, PATRICK
Mailing Address 1 235 ORCHARD ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 235 ORCHARD STREET
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-1688
Tax Map No. section 66.00 block 2 lot 21.000
Cross Street ASHAMOMAQUE
Issue Date: 10/27/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE �; Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � j, Southold, New York 11971
MARRIAGE OFFICER : O It Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `�y�� aPresu Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ':'� ' southoldtown.northfork.net
SC-r- i„Ht OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD -
RECEIVED
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OCT 2 7 2003
, 112
OPERATION PERMIT Southold town Ct r
CESSPOOL or SEPTIC TANK
Residential @ $10 / or Non-Residential @$25 Application No. 4225
Permit No.
394226."-1
Owner Name ��.Tt2 C..(47i6 2..
Owner Mailing Address O)2-CA--$9-t2-P R-t
so-o-r t- 11 Ny it 2 Z/
Owner Property AddressS.444i
Owner Telephone No. i 3/ -76 /6 a D
itow
Tax Map No: Section 141-7 i., Block Lot :3-
Cross
Cross Street Asti-is-ow ifir cp,r6
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.)
C-12=1 ,C. j(21,„JA---
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Signature of Applicant at
Received by:
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