HomeMy WebLinkAboutKelly, Barbara �Ie"
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ELIZABETH A.NEVILLE ���0� � Town Hall, 53095 Main Road
TOWN CLERK Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �'t Southold, New York 11971
MARRIAGE OFFICER %% y �� Fax (631) 765 6145
RECORDS MANAGEMENT OFFICER �__�,( jig *010.' 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. 4075-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner KELLY, BARBARA, SEAN & BRENDON
Mailing Address 1 7425 BAY AVENUE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 7425 BAY AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 631-734-6079
Tax Map No. section 104.00 block 4 lot 29.000
Cross Street BROADWATERS COVE
Issue Date: 4/03/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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'ilOFFICETOWN OFF SOTUTHOLD &OWN CLERK
F� '`;�/
Q Application No. , (�
IsLIZABETH A.NEVILLE,TOWN CLERK ..�`� $10.00 - Residential ✓
P.O.BOX 1179 triPW;
SOUTHOLD,NEW YORK 11971 1�� $25.00 - Non-Residential
Telephone 0.( i % �'.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION RECEIVED
for
APR - 22001
OPERAT ION PERMIT
SEPTIC TANK or CESSPOOL Southold Town
Operation Permit No.
Fee $ /0„67)
DATE 260
OWNER NAME: ! dffa_ ' 'L i:.. _s_.
OWNER MAILING ADDRESS: 7L/25 /4,4-7 /Eve
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OWNER PROPERTY ADDRESS: 7425 6ily xe (,/kk L.,,,C
OWNER TELEPHONE NUMBER: 63( 734"- 6.07q
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TAX MAP NO. : Section 1�d �0 Block , 1(-0z7
I Lot rzl/ O�D
CROSS STREET: is ros�-(- s<-[,t2-6 CQ tie
TYPE OF SYSTEM: Septic Tank X New > Existing
Cesspool K 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.)
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Signature of A plicant
RECEIVED BY: .
Town Clerk's Office
DATE:
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