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HomeMy WebLinkAboutSeifert, J Alice ELIZABETH A. NEVILLE ��_ Y Gt Town Hall, 53095 Main Road TOWN CLERK t P.O. Box 1179 REGISTRAR OF VITAL STATISTICS '� Southold, New York 11971 MARRIAGE OFFICER `� .fi �� �, Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER = �Q *20° Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER •_ �'� OFFICE OF THE TOWN CLERK SOUTHOLD VIRS-NRYOWEIRAMIDDSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4083-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner SEIFERT, J. ALICE Mailing Address 1 360 DOGWOOD LANE Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 360 DOGWOOD LANE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 631-765-9373 Tax Map No. section 54.00 block 8 lot 2.000 Cross Street KENNDY'S ROAD Issue Date: 5/25/01 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) ...,., OFFICE OF THE TOWN CLERK FFO TOWN OF SOUTHOLD � �G Application No.Los?j ELIZABETH A.NEVILLE,TOWN CLERK t $10.00 - Residential ✓ P.O.BOX 1179 SOUTHOLD,NEW YORK 11971 $25.00 - Non-Residential Telephone 4' * $# (516) 765-1801 TOWN OF SOUTHOLD • SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION RECEIVED for MAY 2 5 2001 OPERATION PERMIT 4....4n410 '°y"` clerk SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ G'v DATE P'M/ 2 2 0 / OWNER NAME: Calitcs /j F OWNER MAILING ADDRESS: 4 © 00f . ods-eft, 4,0, _; fri4 i P OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: YC .,r" 93y3 TAX MAP NO. : Section Block Lot 2 CROSS STREET: / k/214/ 7 f 'Q TYPE OF SYSTEM: Septic Tank New Existing Cesspool ✓ 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.) OLjh,rr Signature o Applicant RECEIVED BY: Town Clerk's Office DATE: . a B dv 120 a