HomeMy WebLinkAboutO'Clair, Dennis I
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ELIZABETH A.NEVILLE 1_ V Town Hall, 53095 Main Road
TOWN CLERKP.O. Box 1179
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REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
MARRIAGE OFFICER Fax$ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `�y_'�Ol 41) le Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,,,rrrr
OFFICE OF THE TOWN CLERK
SOUTHOLD W &1T THIMODSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4089-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner O'CLAIR, DENNIS
Mailing Address 1 1492 SKUNK LANE
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1492 SKUNK LANE
Property Address 2
City St Zip CUTCHOCUE NY 11935-0000
Owner Telephone No. 631-734-2124
Tax Map No. section 97.00 block 3 lot 11 .008
Cross Street MAIN ROAD
Issue Date: 6/26/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERKFOU `+' `
TOWN OF SOUTHOLD �G�` Application No.
ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential
P.O.BOX 1179 a
SOUTHOLD,NEW YORK 11971 *.$ $25.00 - Non-Residential
Telephone el41 '�► I
(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: F,✓,v,s
OWNER MAILING ADDRESS: //9�. Skv vsc L.9.v�
Cv oGu, NY //93�
OWNER PROPERTY ADDRESS: /y'92..
Cv--c H o Cv,d ti/Y //935-
OWNER
/93SOWNER TELEPHONE NUMBER: G3/ ?3 Y-2/.2 f
TAX MAP NO. : Section 5 7 Block 3 Lot //
CROSS STREET: li4/ti /Qo
TYPE OF SYSTEM: Septic Tank !/ New Existing
Cesspool New Existing
Residential � Non-Residential
Pol£" /4-s CoN r-
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 Applicant
RECEIVED BY:
Town Clerk's Office
DATE: