HomeMy WebLinkAboutSanders, Thomas O
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ELIZABETH A. NEVILLE ��= Gy� Town Hall, 53095 Main Road
TOWN CLERK ` o P.O. Box 1179
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v, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � Fax(631) 765-6145
MARRIAGE OFFICER � �i Gly �1
RECORDS MANAGEMENT OFFICER 7Ql jip #9,60' Telephone (631) 765 1800
FREEDOM OF INFORMATION OFFICER .9"
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4038-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner SANDERS, THOMAS & LAURIE
Mailing Address 1 PO BOX 5152
Mailing Address 2
City St Zip ROCKY POINT NY 11778-0000
Property Address 1 26481 MAIN ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 631-821-7178
Tax Map No. section 109.00 block 2 lot 13.006
Cross Street CROWN LAND LANE
Issue Date: 6/30/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
'ICE OF THE TOWN CLERKS�FFO(,(tC"
TOWN OFSOUTHOLD � Application No.Lia3
ELIZABETH A.NEVILLE,TOWN CLERK ..` $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 *.$ $25.00 - Non-Residential
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Telephone =01f g'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION JUN 3 0 2000
for kau rhold town Clerk
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 9- \ —c
OWNER NAME: -MOWS -k- jkve.Ar. 5 1
OWNER MAILING ADDRESS: P,O, euC StSa'
-• 11 U rr a
OWNER PROPERTY ADDRESS: c` (p-((j Q
Cahl� . 11 13 s
OWNER TELEPHONE NUMBER: *[3q -LtOCia- gal
TAX MAP NO. : Section tO9 . 00 Block G Lot 1 J OO(O
CROSS STREET: CruoN Likt3b. LAiQ,,- 1ot) EaS'-
TYPE OF SYSTEM: Septic Tank 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.)
seu4s,Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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7 ‘),3112
NOTE: LOCATION OF-ADJOINERS WELLS AND CESSPOOLS
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BY OTHERS AND ARE NOT GUARANTEED.
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