HomeMy WebLinkAboutClarke, Christopher ,110 SpFF014
ELIZABETH A.NEVILLE * ; Town Hall, 53095 Main Road
TOWN CLERK ; h - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v' Al Southold, New York 11971
MARRIAGE OFFICER ``O�i �� ' Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �Ql ,' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - -_ •� �� ����
OFFICE OF THE TOWN CLERK
SOUTHOLDtollATSIBrRIIJSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4109-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner CLARKE, CHRISTOPHER
Mailing Address 1 PO BOX 768
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1865 YOUNG'S AVENUE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 631-734-2864
Tax Map No. section 60.00 block 1 lot 3.000
Cross Street HUMMEL AVENUE
Issue Date: 10/25/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
M
OFFICE OF THE TOWN CLERK SSW FJ q
TOWN OFSOUTHOLD , ��, 0 Application No. "I 16 1
1IIZABETHA.NEVILLE,TOWNCLERK ..� i $10.00 - Residential -� J
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 , ��� $25.00 - Non-Residential
Telephone _ej 11 •
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
apCElVED
OPERATION PERMIT
2001
SEPTIC TANK or CESSPOOL OCT 25
zournota town Clerk
Operation Permit No.
Fee $
DATE l —(72.5/, 6 /
OWNER NAME: Ci
L -�
OWNER MAILING ADDRESS: V j X 7-(
It 3 S'
OWNER PROPERTY ADDRESS: O � 1)v1 6 S ---�
OWNER TELEPHONE NUMBER:61 Pr 7— t f Z Fb
TAX MAP NO. : Section !Q Q Block / Lot 3
CROSS STREET: ..444- N u y4-14 r
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool v 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.)
• nature of pplicant
RECEIVED BY: •
Town Clerk's Office
DATE: