HomeMy WebLinkAboutLessard, Ruth ' )FFOL,'
ELIZABETH A. NEVILLE ���' Gy : Town Hall, 53095 Main Road
TOWN CLERK ; H 2 t P.O. Box 1179
REGISTRAR OF VITAL STATISTICS V.647$� Southold, New York 11971
MARRIAGE OFFICER � y Fax(631) 765 6145
RECORDS MANAGEMENT OFFICER �_�0( *9-060. Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - rrr
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4067-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner LESSARD, RUTH
Mailing Address 1 875 ALVAH'S LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 3000 WICKHAM AVENUE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 631-298-8702
Tax Map No. section 139.00 block 3 lot 4.001
Cross Street GRAND AVENUE
Issue Date: 1/22/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK COFDke -
TOWN OF SOUTHOLD
CQ Application No.' 6
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ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residentia l
P.O.BOX 1179
SOUTHOLD,NEWYORK 11971 ;t $25.00 - Non-ftesidential
Telephone *01 , "
(516) 765-1801
TOWN OF SOUTHOLD
• SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
OWNER NAME: 676t LC s44j
OWNER MAILING ADDRESS: R75-- ALu.¢gs LA
C rC'AO vet" /195
OWNER PROPERTY ADDRESS: 3000 cklIehn Avg--
mo 77-n-tic
v6m,77-rrtic k. "A/ 19r-
OWNER TELEPHONE NUMBER: Z41f- 37oz
TAX MAP NO. : Section / 3 T Block 3 Lot '1.
/
CROSS STREET: 4.24r/T dtvel 4.k/1. ,e9uif AtA Ccwklial RC/-
TYPE
/TYPE OF SYSTEM: Septic Tank ' New i Existing
Cesspool New Existing
Residential L/ 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.)
Signature of Applicant
RECEIVED BY: /(0/
Town Clerk's 0
DATE:
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