HomeMy WebLinkAboutHoeg, Thomas ELIZABETH A. NEVILLE �� � Town Hall, 53095 Main Road
TOWN CLERK co - P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
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1i � �� Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4117-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner HOEG, THOMAS AND MARYLYN
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Mailing Address 1 2105 ARBOR LANE
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Mailing Address 2
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City St Zip MATTITUCK NY 11952-0000
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Property Address 1 2105 ARBOR LANE
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Property Address 2
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City St Zip MATTITUCK NY 11952-0000
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Owner Telephone No. 000-000-0000
Tax Map No. section 113.00 block 7 lot 23.000
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Cross Street BERGEN AVENUE
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Issue Date: 1/29/02 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
o TOW No SOMHo nom` g�1FF0iK� 7
ELIZABETH A.NEVRIE,Town CLERK Application No. // /
P.O.BOX 1179 j
SoUTHOLD,NEW YORK 11971 0 T
bra Iion
Telephone �,� ��Q $10.00 -Residential
(631) 765-1800 1 $25.00melon-Residential
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for OPERA(10%
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: �,q�.�j �F�i•�H ��
APPLICANT ADDRESS: LJ
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: —r-f-6 e--. A ^J ap
OWNER MAILING ADDRESS: Z I o S TA IL l.,w_&_g_
OWNER PROPERTY ADDRESS: Q A` LA* _�
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TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section r l3 Block "T Lot o1�
CROSS STREET: i t 441-t
BUILDING PERMIT NUMBER CROSS REFERENCE: 2ee.G ZJ
S ature o A scant
RECEIVED BY:,—^ <z
own Clerk's Office
DATE:
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