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ELIZABETH A. NEVILLE ��_ �� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �, Southold, New York 11971
MARRIAGE OFFICER �` y � 1', Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER /), �`4-06ii� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,,�•1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4064-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner SUTTON, ALEXANDER & TERRY
Mailing Address 1 PO BOX 70
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 325 HORTONS LANE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-765-3856
Tax Map No. section 63.00 block 5 lot 17.000
Cross Street MAIN ROAD
Issue Date: 12/11/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
4 . 11
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ORNiCEOF THE TOWN CLERK �FCOI
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TOWNOFSOUTHOLD �� Application No. 110(4-(
l3LIZAB$TH A.NEVILLE,TOWN CLERK �� $10.00 - Residential
P O.BOX 1179 a
SOUTHOLD,NEWYORK 11971 *.,%` $25.00 - Non-Residential
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Telephone _Ol *
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for RECEIVED
6 2000
OPERAT ION PERMIT DEC
�*.:.. rrvrnr IfownClerk
SEPTIC TANK or CESSPOOL
Operation Permit No. c - 55R
t �b
Fee $ k0,
DATE ii 129/00
OWNER NAME: itl aev T'ac7 W1. 5u 1t-otJ
OWNER MAILING ADDRESS: ?,c2. aoic -70
SoolJ ,ter Icy-u
OWNER PROPERTY ADDRESS: 325 Ho{+0105 1-c,
OWNER TELEPHONE NUMBER: 631 - 765--3'65-6
TAX MAP NO. : Section 63 . 0v Block 5 Lot 17. 0"
CROSS STREET: Roc
TYPE OF SYSTEM: Septic Tank x New X Existing x
Cesspool 9t New Existing
Residential x 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.)
qLicant
RECEIVED BY:
Town Clerk's Office
DATE:
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