HomeMy WebLinkAboutMartinez, David ,/
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ELIZABETH A.NEVILLE ��_ OGyd Town Hall, 53095 Main Road
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TOWN CLERK H P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 1xO
,�� Southold, New York 11971
MARRIAGE OFFICER ‘ 1i �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �__�Ol .‘NY Telephone (631) 765 1800
FREEDOM OF INFORMATION OFFICER _ p
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4025-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner MARTINEZ, DAVID & SUZANNE
Mailing Address 1 PO BOX 1583
Mailing Address 2
City St Zip MATTITCUK NY 11952-0000
Property Address 1 1700 ARBOR LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 631-298-0109
Tax Map No. section 121 .00 block 1 lot 1 .010
Cross Street BERGEN AVENUE
Issue Date: 5/11/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
C 111 II "a
OFFICE OF THE TOWN CLERK S\IFFO1. 4`;"
TOWN OFSOUPHOLD Application No. //G �5
piZABETH A.NEVILLE,TOWN CLERK % $10.00 - Residential )(
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 *.1��%i $25.00 - Non-Residential
Telephone 'f'�j * Nt% o''
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME:. `I , iIc► aatA 51,I.Zalt,i1 '-klvcz_
OWNER MAILING ADDRESS: Pct 10,1(
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OWNER PROPERTY ADDRESS: vim) Arbor La n.e
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OWNER TELEPHONE NUMBER: (1_94a9'6-0(p9
TAX MAP NO. : Section I Q I .00 Block 1 Lot I 00
CROSS STREET: ( er
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool) Existing
' - '8ential 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.)
Inta*th,,s2
ignatu of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
FROM : DEPENDABLE HYDRAULICS FAX NO. : 151E9426846 Apr. 20 2000 07:24cIM
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