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HomeMy WebLinkAboutRudnitsky, Diane 0.0 00 ;G ELIZABETH A.NEVILLE ���_ y�: Town Hall, 53095 Main Road TOWN CLERK o - % P.O. Box 1179 ti Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS 0 Fax(631) 765-6145 MARRIAGE OFFICER �,iL ` �1� RECORDS MANAGEMENT OFFICER = #����1 Fax (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. 4195-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner RUDNITSKY, DIANE Mailing Address 1 550 ALBO DRIVE Mailing Address 2 City St Zip LAUREL NY 11948-0000 Property Address 1 550 ALBO DRIVE Property Address 2 City St zip LAUREL NY 11948-0000 Owner Telephone No. 000-000-0000 Tax Map No. section 126.00 block 3 lot 1.000 Cross Street WELLS ROAD I ' aZkoPWAr • Issue Date: 4/01/03 zabeth A. Neville Southold Town Clerk (TOWN SEAL) 'OFFICE OF THE TOWN CLERK OC��FMee,-TOWf ELIZABETH ANNEOF LJFTHOLD TOWN CLERK ,`� � ; Application No. J :G t $10.00 - Residential P.O.BOX 1179 � ` SOUTHOLD,NEW YORK 11971 ? $25.00 - Non-Residential Telephone % 44 ��, (516) 765-1801 ' TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE 3/0/03 OWNER NAME: /11,i//% 1l v19N/2-5 iY OWNER MAILING ADDRESS: 5 c v MtiSo Ok--- . / OWNER PROPERTY ADDRESS: cc() /It 60 D," LrittJ2 5Z. ' OWNER TELEPHONE NUMBER: TAX MAP NO. : Section tZ 6 Block ©° 3 Lot 00 1 CROSS STREET: Ge LLS /20-- TYPE 20_TYPE OF SYSTEM: Septic Tank New Existing Cesspool / New i Existing Residential i/ 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.) 4 ,a, r�22 Signature of • pplic t RECEIVED BY:301 114 Town Clerk's Office . E DAT : 3/3 1 0 3 1. Y _��1jFf0(,� OFFICE OF THE TOWN CLERK ro`""� �'" TOWN OF SOUTHOLD ,,.�="DE. Q i x o€%;, ELIZABETH A.NEVILLE,TOWN CLERK ! ,T,-)1.,-,„..D b► •t, 4 53095 MAIN ROAD U 70)D .LEFT ly0 ADD A i P �' r'? i- . 1* is„.' SOUTHOLD,NEW YORK 11971 Q P.O.BOX 1179 UN,BLE TO OR�ARD "�`'cU Ar,.,_. _ . - Q()NCI a NOT 1fNOWN , - NO c ED REFUSED i • 0LI NDTREMREET-NDMgE RECEIVED �. R SUFFLCIEN RIL IN THIS EN EL p NO MAIL RECEP A, CI VA CLOSED ND ORDS APR 4 2003 Diane Rudnitsky 550 Albo Dr Southold Town Clerk Laurel NY 11948 I hi iii j # i j y i s y i,iit �'t #hit#2 til�i�tstr#+I1t!!It i_I t1 i_,:. Fl II • . 4