HomeMy WebLinkAboutFeeley, Michelle ELIZABETH A. NEVILLEt _ `: Town Hall, 53095 Main Road
TOWN CLERK ; H P.O. Box 1179
REGISTRAR OF VITAL STATISTICS $ Southold, New York 11971
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MARRIAGE OFFICER �� y �1 Fax(631) 765 6145
RECORDS MANAGEMENT OFFICER .�� ��' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER 'oo��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4063-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner FEELEY, MICHELLE & RICHARD
Mailing Address 1 P 0 BOX 1917
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 3430 BOISSEAU AVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-4699
Tax Map No. section 550.00 block 300 lot 9.000
Cross Street YENNECOTT DRIVE
Issue Date: 12/05/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �FFOii k30
TOWN OFSOUTA�OLD ��oo �0 % Application No.
F�LIZABETH A.NEVILLE,TTWN CLERK � $10.00 - Resid6ntia I t/
P.O.BOX 1179
SOUTHOLD,NEWYORK 11971 'crs ,.'1 $25.00 - Non-residential
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Telephone m4 * 1P:i•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
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for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. ,af
Fee $ /0.0-6
DATE 1Z]?11)Q
OWNER NAME: 11/44 tejlal -reiztEy
OWNER MAILING ADDRESS: Po pyy iai1
£ 00-r-fiDth my 1R1J
OWNER PROPERTY ADDRESS: 74 b9(SS A) U
I; 14 1 1Qi/
OWNER TELEPHONE NUMBER: (9JI 1 14 q
TAX MAP NO. : Section 65 Block 5 Lot "1
CROSS STREET: • 4, S. .y j( IL! V P-
TYPE OF SYSTEM: Septic Tank i/ 10 Existing
Cesspool V/ (GI?) Existing
pp
Residential 1Z / 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.)
'WA/ a i
Signature o .pplicant
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RECEIVED BY: )
Tow Jerk's Office
DATE:
N
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unauthorized alterationor addition
'7-E0,/7.64E to this survey Ie a violation
of
Section 720e of the New York Stats
ce, 2.8,a Education Law.
OL E.tow-✓V/dlY Copies ofNssurvey mop net bearing
/t _ LeAM the land surveyors inked sealer
embossed sell shad not be considered
AIa s•Wociny I
to be a%Md We Copp.
MI 0/gr
---— ousnnMsa indicated Moan shall runt
'<c=� , i ppr nlypw,amend on bbehllwhom llie M
rand
F` ee.e tide tion listed amend
B 4V five >3 3,3 yar to the assignees of the Isndno IrNMAon.
Guarantees v*not transferable
X4,41 V, /O �s additional Institut!-is or subsequent
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