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JUDITH T.TERRY t �� Gym Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
T Southold,New York 11971
REGISTRAR OF VITAL STATISTICS \ O
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� $ Fax(516) 765-1823
MARRIAGE OFFICER \#* 1�
RECORDS MANAGEMENT OFFICER ; �,( * %►a•0 06� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER -- .,,°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3647-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner HAAG JR, JAMES
Mailing Address 1 45 WEST 11TH STREET
Mailing Address 2
City St Zip NEW YORK NY 10011-0000
Property Address 1 4725 ORCHARD STREET
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-3950
Tax Map No. section 27.00 block 2 lot 2.006
Cross Street NARROW RIVER ROAD
Issue Date: 6/18/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
...
`OFFICE OF THE TOWN CLERK .c0FU(,(-
Town of Southold , . e4% Application No.3
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road $10.00 - Residential
P. 0. Box 1179 u-31 ;'
Southold, New York 11971 $25.00 - Non-Residential
Telephone
0-1/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. t_4-F",
Fee $ •
DATE g � 7/V
OWNER NAME: J S \-\"„49
•
OWNER MAILING ADDRESS: 4-5— 03. ( (114 , 1--;
, Gall
OWNER PROPERTY ADDRESS: Al ficIf
r 0157
OWNER TELEPHONE NUMBER:
TAX MAP NO. : Section 21. e Block Lot - (:)()C''
CROSS STREET: Nk. °c 2 g(U
TYPE OF- SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential V 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 •
II Art Directions, Inc.
PO Box 310
RECEIVED BY:A AP Orient, NY 11957
Town ' lerk's O-fice _
DATE: �' � `'
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4
01
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JUDITH T.TERRY
������ ?, #,), Town Hall, 53095 Main Road
TOWN CLERK y ; P.O. Box 1179
; ' rtr � Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER l- 1.a,. Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER „
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1489 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ART DIRECTIONS INC.
Address 1 : P.O. BOX 310
City St Zip ORIENT NY 11957
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR A NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF: #R10-96-26
Name Of Owner HAAG, JAMES, JR.
Mailing Address 1 45 WEST 11TH STREET -
City St Zip " NEW YORK NY 10011
Property Address 1 11.725 ORCHARD STREET
City St Zip ORIENT NY 11957
Tax Map No. section 27.00 block 2 lot 2.006
Cross Street NARROW RIVER ROAD
Building Permit Number Cross Reference:
•
Issue Date: 6/07/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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