HomeMy WebLinkAboutOlmstead, Sarah 1
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ELIZABETH A. NEVILLE _� � Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER �� 4% ��1', Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =__ 1 �a ,i' Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER �
OFFICE OF THE TOWN CLERK
SOUTHOLD WAVAIDLATIERTIIIMPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 41060-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner OLMSTEAD, SARAH
Mailing Address 1 309 W. 93RD STREET
Mailing Address 2
City St Zip NEW YORK NY 10025-0000
Property Address 1 365 MAJORS POND ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 631-323-1455
Tax Map No. section 2.60 block 20 lot 39.015
Cross Street KING STREET
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Issue Date: 9/14/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF TUE TOWN CLERK COFUL4`,-
Application No. /flo�
• TOWN OF SOUTHOLD07 int t;
FIIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential L�
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 $25.00 - Non-Residential
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Telephone *fid * Or/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLI CAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE /i3/ei
OWNER NAME: SraX O/rnse&/
OWNER MAILING ADDRESS: 307 cv 730 d 5t
OWNER PROPERTY ADDRESS: 36 "kfa o.s
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OWNER TELEPHONE NUMBER: 3..25 'f$
TAX MAP NO. : Section 2c, Block Z- Lot 39, i5
CROSS STREET: /�iKS ,Sty,
TYPE OF SYSTEM: Septic Tank / New K Existing
Cesspool New d Existing
Residential Y 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.)
Gam.
lignature of Applicant
RECEIVED BY: (V"
Town Clerk's Office
DATE: ?// �
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