HomeMy WebLinkAboutHiggins, Daniel • t
✓'- "
• r OFFICE OF THE TOWN CLERK OC,�FFRC'
TOWELIZABETH NNEVILLE ,HOWNCLERK �OFSOUTOLD � Application No. gs1,3
P.O.BOX 1179 a $10 00 - Residential
SOUTHOLD,NEWYORK 11971 'W$ $25.00 - Non-Residential
Telephone O-cfj * `�� ,'
(516) 765-1801 - ',
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for RECEIVED
OPERATION PERMIT JUL 3 1 ,inn?
SEPTIC TANK or CESSPOOL
Southold Town Clerk
Operation Permit No.
Fee $ •
DATE
OWNER NAME: ,D071/1& /71/ Oa /iJ s' ANINVONIFY
OWNER MAILING ADDRESS: ri / . a `_-__, <
)Cer j9/ /i92k 12)4! //d4/
OWNER PROPERTY ADDRESS: /7/ 4//e4 Ale /11
E. 0; Boa Al.�
OWNER TELEPHONE NUMBER: 144( — g,29 ---/...1 7'
TAX MAP NO. : Section g®6 Block 3r Lot 4 - .:2S-
CROSS
SCROSS STREET: C igv -1,4,-;447
TYPE OF SYSTEM: Septic Tank Y New Existing
Cesspool New 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.)
0 /
®
Sign•'ure • Ala:,Ica
RECEIVED BY:
wn Clerk's Office
DATE:
Gomm NY 'V,
74-08-02 S
?-27-02
I LOGATION 04-02-03
-17-03, FINAL 07-15-03
)UNTY TAX #
• 4 - 25
r.
c, �o
MINS \ .3.
c, -\oma
o Scc\
UNTY DEPT. OF c•
VICES REF. ��
3 77 `-p-
‘,,0-'
�0 ��' 7� �\-'F-a
• 463a'L3 ,
o , (if'� ,- ,5�
A c\\S
V 9
spy _\
9, die G
'P C,&'
g f�
c\ yep
�� �p�0� / -Si 993
to S Z
.....i ...c.,,,,L., �r�„ -
` A
---
,_
Ne cv, ‘5
,,
�a , "ii 7,,,i5 „ „,
v,
<*
0 I • Z
F- Yrs
'
1\ ‘01° , . .
i 1 j0/ Al
1 1 ul; �/ O /W\
P.
-p o »Y��
•
/� ./ 07,3 3
l ' \ . S63 0`