HomeMy WebLinkAboutHokanson, Richard ow
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ELIZABETH A.NEVILLE ����� y1: Town Hall, 53095 Main Road
TOWN CLERK ; y 2 ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �� y'/ ���1,, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER O! 0 � Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4060-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner HOKANSON, RICHARD M
Mailing Address 1 40 JOMAR ROAD
Mailing Address 2
City St Zip SHOREHAM NY 11786-0000
Property Address 1 1635 NOKOMIS ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-744-9039
Tax Map No. section 78.00 block 3 lot 33.000
Cross Street HIAWATHA'S PATH
Issue Date: 11/30/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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- ONCE OF THE TOWN CLERK CjVFW`," _ '
TOWN OF SOUTHOLD � s cf.
:4Application No. (1aco
ELIZABETH A.NEVILLE,TOWN CLERK . $10.00 - Residential
PO.BOX 1179 a „
® OLD,NEWYORK 11971 �,��� $25.00 - Non-Residential
Telephone % Jit ' �'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for RECEIVED
OPERATION PERMIT NOV 3 0 2000
SEPTIC TANK or CESSPOOL
/ cy Southold Town Clerk
Operation Permit No. Z '{ 6 / R
Fee $ /'0
DATE iitZt'i /2_0o0
OWNER NAME: /e/L h 4-r 1 ti 0 44 nes o Al
OWNER MAILING ADDRESS: /O/ 3.---c. i' RD.
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h� rch4,i , i✓% // 786
OWNER PROPERTY ADDRESS: 16 3 r AA.) k1$ fi 0
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OWNER TELEPHONE NUMBER: 6 3 I - 7q 1 - 903, Y .4 1" U /- )//‘ 4--,
TAX MAP NO. : Section 7 ?5 Block 03 Lot 33
CROSS STREET: kg-c,./41--/-4 g /41--R
TYPE OF SYSTEM: Septic Tank New a.. Existing
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Cesspool G' 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.)
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Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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unauthorized alteration or addition
///404/,W VIP�f�,"'� to this survey b a violation of
�7 �7 ✓ Section 720a of he Nevi York Stan
Eduudon Law.
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