HomeMy WebLinkAboutSmith, John OFFOQN
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ELIZABETH A. NEVILLE �1_ y1 Town Hall, 53095 Main Road
TOWN CLERKy P.O. Box 1179
REGISTRAR OF VITAL STATISTICSSouthold, New York 11971
MARRIAGE OFFICER ���y �� �, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER _�Ol �� ��� 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. 4062-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner SMITH, JOHN C
Mailing Address 1 465 TOWN HARBOR LANE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 935 JACOBS LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-5325
Tax Map No. section 79.00 block 6 lot 4.006
Cross Street BAYV I EW ROAD
Issue Date: 12/05/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK OCA j'
TOWN OF SOUTHOLD `1 ��, COi� Application No.
ELIZABETH A.NEVII.I.F,TOWN CLERK $10.00 - Residential
P.O.BOX 1179 g .
SOUTHOLD,NEWYORK11971 *'1,�; $25.00 - Non-Residential
Telephone _01 , Y1� i'
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION RECEIVED
for r DEC — 4 2000
OPERATION PERMIT
Southold Town Clerk
SEPTIC TANK or CESSPOOL
Operation Permit No.a.' 1 1 ci.-
Fee $ 14(0 , p-0
DATE ,/ov a,lo) l q f
OWNER NAME: Z--
OHM G gm i A
OWNER MAILING ADDRESS: 7G,' /OAR) /,'A0-80P- l4A)
Sowt14oL0 , AtAii 1147)
OWNER PROPERTY ADDRESS: 93r .. •cogs LAII'
so/4-046 L� A 1 / 01/
OWNER TELEPHONE NUMBER: 7,6,E S32-S
TAX MAP NO. : Section 7 9 Block 6 Lot 4/) ‘
CROSS STREET: /3Ay V/6w AVk-.
TYPE OF SYSTEM: Septic Tank yes New l/ Existing
Cesspool v6S' New /V Existing
Residential Non-Residential j.
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.)
/
1 is ' /
,Signature of Applicant
RECEIVED BY: ez
T.5
wn Clerk's Office
DATE: 4 co
C.7\1777.1
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