HomeMy WebLinkAboutHall JUDITH T.TERRY �� le� Town Hall, 53095 Main Road
TOWN CLERK
P.O. Box 1179)
�� Southold,New York 11971
R.
REGISTRAOF VITAL STATISTICS �1Fax(516)765-1823
MARRIAGE OFFICER \� ® �
RECORDS MANAGEMENT OFFICER i ®� *IVTelephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER •o
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3705-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HALL, CHRISTINE
Mailing Address 1 760 LONG CREEK DRIVE
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 760 LONG CREEK DRIVE
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-1378
Tax Map No. section 55.00 block 4 lot 8.000
Cross Street LAUREL AVENUE
Issue Date: 10/21/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK S�FFo C-
Town of Southold � QG Application No.
Judith T. Terry, Town Clerk �
Town Hall, 53095 Main Road $10.00 - Residential
P. O. Box 1179 u' • iii z' $25.00 - Non-Residential
Southold, New York 11971 OO �o ��`
Telephone ( * �i
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
$ foo
Fee
DATE Ot 17
OWNER NAME: CIisint ii,e7 i I
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS : 1-76 1 J.01) C /3 r4',_
S0icu.¢A.m/d I y
OWNER TELEPHONE NUMBER: 17(0S-- 139r
TAX MAP NO. : Section - Block Lot ,
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing,
Cesspool New Existing
\if
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.)
41'(4
Signature of Applicant
RECEIVED BY: a
Town erk's Office
DATE:
4
'' _, ','1 SOS RENSSELAER G. TERRY, Jr. •
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