HomeMy WebLinkAboutShearin, John ,,,,i/iii,,,-
St%FOI4'
ELIZABETH A. NEVILLE AP V Town Hall, 53095 Main Road
TOWN CLERK O - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS i Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER `'*O,4i -00
FREEDOM 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. 4201-R Residential x Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner SHEARIN, JON
Mailing Address 1 2670 STILLWATER AVE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 2670 STILLWATER AVE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 631-734-5771
Tax Map No. section 136.00 block 2 lot 17.001
Cross Street TRACK AVENUE
•
Q evc
Issue Date: 5/09/03 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
•. tee
OFFICE OF THE TOWN CLERK /COMee,
ELIZABETH�ANNEVOF IIO.LIE SOUTHOLD
CLERK � #V- Application No. 1 a
$10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 �+ $25.00 - Non-Residential
Telephone 0,! ` k ' 1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ Jp : DO
DATE 5i4 d
OWNER NAME: eJc h
OWNER MAILING ADDRESS: Za.7o S -r 1lvvecke) 'ye
Gc+---ch o e ay i
OWNER PROPERTY ADDRESS:
•
OWNER TELEPHONE NUMBER: 734-6:171
TAX MAP NO. : Section 13b Block iR Ldt / 7 , DD I
CROSS STREET: rA Ave- ,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New i/ 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.)
le/E7
nature of pp ican4 t m
RECEIVED BY: 4, VA-A-
Apr T, wn Clerk's Office
DATE: r /03
-TW- V
(._ r 97 CA,W OriTIL
\)S‘.::
, e \J
.) t Oz --may