HomeMy WebLinkAboutThomas, Maria ELIZABETH A. NEVILLE t 4d\ Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
H Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER `�a�00,��, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ��
OFFICE OF THE TOWN CLERK
SOUTHOLD rPGAS1V RwAgnatzrR( R SAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4107-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner THOMAS, MARIA
Mailing Address 1 PO BOX 2100
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 1105 KAYLEIGHS COURT
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 631-477-1300
Tax Map No. section 22.00 block 3 lot 5.004
Cross Street MAIN ROAD
Issue Date: 9/25/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK c31FO(,r4 I
TOWN OF SOUTHOLD 0,% Application No. I
ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 zt $25.00 - Non-Residential
Off"�:
Telephone 01 440:04.i :'
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Q CEIVED
APPLICATION
SEP 2 1200
foreyyn Clerk
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 25/6
Fee $ (t.
DATE /ZOJ
OWNER NAME: fl41< iii -77teiginS
OWNER MAILING ADDRESS: f .to% 2-100
OWNER PROPERTY ADDRESS: /t 6 �„C/( /#(3 (Qc)
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OWNER TELEPHONE NUMBER: Lf77 — j
TAX MAP NO. : Section Z Block 3 Lot
CROSS STREET: MR/A/ /oof92
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.)
Signature of App
RECEIVED BY:
Town Clerk's Office
DATE:
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