HomeMy WebLinkAboutFouchet, Michael r ��# pS�FFO(, `,
ELIZABETH A. NEVILLE �� 7.4 Town Hall, 53095 Main Road
TOWN CLERK H P.O. Box 1179
�s• Pr, i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 11
MARRIAGE OFFICER .f� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =_�49,� .������� 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
t211'
Operation
Operation Permit No. 40720-R Residential X Non-Residential
Fee $ 100.00 New X Existing
Name Of Owner FOUCHET, MICHAEL AND JUDI
Mailing Address 1 1075 SHIPS DRIVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1
Property Address 2
City St Zip 00000-0000
Owner Telephone No. 631-765-6018
Tax Map No. section 790.00 block 300 lot 35.000
Cross Street NORTH BAYV I EW ROAD
Issue Date: 2/26/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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0FFIOWNOFSOTOWN
UTHOLDCLERK
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TG ` Application No.
Q
ELIZABETH A.NEVILLE,TOWN CLERKyG $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 ���, $25.00 - Non-Residential
Telephone _ O1 * �g s�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
• for
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.022(1'`
Fee $ ZO 100
DATE c.1-AX.070 /
OWNER NAME: / ' )id1&Gl GLro! (.7,-17,l �d z
OWNER MAILING ADDRESS: 1075 <5r4S
&<4.5q20 Id, kW 11_9'7i
OWNER PROPERTY ADDRESS: fp 76' 6kc)/05 �y
t$V1.44Vee 004 1157/
OWNER TELEPHONE NUMBER: 1 - 6 S ' tDn
TAX MAP NO. : Section /000179 Block v.5 Lot 35 ,
CROSS STREET: 9\11a/ *. ` a1Vlc - Li
TYPE OF SYSTEM: Septic Tank N NeXj Existing
Cesspool N 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.)
Signature of App icant
RECEIVED BY:
Town Clerk's Office
DATE: A/6, 6 /'l
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