HomeMy WebLinkAboutJohnston, E Brownell •
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ELIZABETH A. NEVILLE �� = Z`: Town Hall, 53095 Main Road
TOWN CLERK ; y Z •
t P.O. Box 1179
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i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Q #
MARRIAGE OFFICER �� y,L O�1Fax (631) 765 6145
RECORDS MANAGEMENT OFFICER 7�� .�a ��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - ,•i��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4045-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner JOHNSTON, E. BROWNELL & KAREN
Mailing Address 1 PO BOX 534
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 4001 WELLS ROAD
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 631-447-9092
Tax Map No. section 86.00 block 1 lot 9.004
Cross Street WELLS ROAD
Issue Date: 9/29/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
29/09 '00 FRI 09:21 FAX 516 765 6145 SOUTHOLD CLERK a 001
*** TX REPORT ***
*********************
TRANSMISSION OK
TX/RX NO 1766
CONNECTION TEL 4479093
CONNECTION ID
ST. TIME 29/09 09:20
USAGE T 01'18
PGS. SENT 3
RESULT OK
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ELIZABETH A.NEVILLE � � A
Town Hall, 53095 Main Road
TOWN CLERK ` y P.O. Box 1179
REGISTRAR OF VITALSTATISTICS �+' ���
_ i Southold,New York 11971
MARRIAGE OFFICER � Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =y�i0! ..% c.', Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _s ��,, •'�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
FAX TRANSMITTAL
TO: e.
FROM: 1rQ& ( b,-L
r
DATE: �I" a
m a
Number of Pages (including cover): 3
If total transmittal is not received,please call(631)765-1800.
COMMENTS: CA-L" --12-11AAJIP-3-L
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ELIZABETH A.NEVILLE ��$1"0# y� Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
H = Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 1�
MARRIAGE OFFICER ?,i/ ��F�1�
Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = '/Ql *a0
'i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ ��.9
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
FAX TRANSMITTAL
TO: C~
FROM:
DATE: a 9 a x d
Number of Pages (including cover): 3
If total transmittal is not received, please call(631)765-1800.
ju,td.0-14-1-CO
COMMENTS: 3, J--15-1 - CUL"
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /10 (1,.....c—
Fee
-U (1J
Fee $ /,0 .0C) 52A9/°0(�
DATE ! ��/°�'
OWNER5NAME: E. criedvVn/Ei__ , oHN57-0AJ e /</ EN 8. .1-O///\/S7OA/
OWNER MAILING ADDRESS: P.D. PJOX 531i
/.li YocK / 959- 05341
OWNER PROPERTY ADDRESS: ,'/C1-11140n/6 CWEE , F4 A-1
4/00/ VQ I-LS Rb. � PE coin/ e. v v 1195 g
OWNER TELEPHONE NUMBER: C 4P.3/) q4717- `?0Y2..
TAX MAP NO. : Section (v, 00 Block I Lot q. O o z.j
CROSS STREET: /4,4/A/ /2oAt>
TYPE OF SYSTEM: Septic Tank q< New k( Existing
Cesspool New _Existing
Residential DC 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.)
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i :ignature of Applicants
RECEIVED BY: 1(
Town Clerk's Office
DATE: / /D/c2
05/21;'2000 19:53 516765E1 a7 MILL CREEK BUILDERS PAGE 91
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96-21-08 19 :49 RECEIVED FROM:5167656107 P- 91
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