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HomeMy WebLinkAboutElliott JUDITH T. TERRY z � Town Hall, 53095 Main Road TOWN CLERK ® r ; P.O. Box 1179 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS = %" Fax (516) 765-1823 MARRIAGE OFFICER �_®.j� � — et.400 Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER ® ,�1� FREEDOM OF INFORMATION OFFICER ,0 FREEDOM OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3261-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner ELLIOTT, CHRISTINE Mailing Address 1 P. O. BOX 1300 Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 560 LEGION AVENUE Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-5115 Tax Map No. section 142.00 block 2 lot 10.000 Cross Street PACIFIC STREET Issue Date: 10/18/94 Judith T. Terry Southold Town Clerk (TOWN SEAL) tr: tir • OFFICE OF THE TOWN CLERK ��FO ' Town of Southold O� �Ql'?, Application No.3� Col Judith T. Terry, Town Clerk .� r ° h» y:\ Town Hall, 53095 Main Road $10.00 - Residential P. O. Box 1179 = ;) $25.00 - Non-Residential Southold, New York 11971 O� •��` Telephone ei ,g �e; i'� (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for • OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE /Oh hY OWNER NAME: 6Risr/Ai T 7L OWNER MAILING ADDRESS: / ,SOX /367) 4MT-7 k 111 //t.5Q OWNER PROPERTY ADDRESS : ySZD /,e4/6A/ ,4l/�/(1(J.E l4T � ,/ /J/ // R OWNER TELEPHONE NUMBER: qj/ 079f- 797- 3,f/ TAX MAP NO. : Section /3/a . Q6' Block o2 Lot /Q - DDD CROSS STREET: - / nG/p/G�• TYPE OF SYSTEM: Septic Tank New Existing Cesspool X New X Existing Residential X 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.) ;'/ (i Signature of-Applicant RECEIVED BY: Town Clerk's Office DATE: 4 t 0 r 09' FEd SI r SU: ��'� \,tP• P IS? 004 e°� �a , .�� , , Gep0 p A T V � Fo off. .06 ,k,: ��, �� TOWN 1 00g�°�� •,� 70 SUFFOL. odor Elk'ok •••,-, �, �, X000 - �� g 'c--. , �NA Sc. ev„ P 0 '- na '1. �� IN, 1:46 ted', "., �o� iN°eyo 0 011/4 . ‘ e e.,‘ 4 dl) Z elieri.,‘ -7So O iiiti \ V, �' i „scyst fro fiIN \ . ti41. p i A Ou I CI* eod° \• \ Prepared in accordance with the minimum Standards for title surveys as established % 0 �' I by the L.I.A.L.S and approved and adopted 44. 124 Z V d'for such use b'y The New York Stole Larrd / -.