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)
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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
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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.)
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Signature of-Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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Standards for title surveys as established % 0 �'
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