HomeMy WebLinkAboutHallenbeck •11 OFF00,
JUDITH T.TERRY ����`S° ft
Town Hall, 53095 Main Road
TOWN CLERK 1 • P.O. Box 1179
t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Vt5 $ Fax(516) 765-1823
MARRIAGE OFFICER ��
,
RECORDS MANAGEMENT OFFICER ` ®,( 41°,01� 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. 3637-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HALLENBECK, GEOFFREY
Mailing Address 1 P. O. BOX 806
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 1560 PIKE STREET
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-4151
Tax Map No. section 140.00 block 3 lot 17.000
Cross Street WICKHAM AVENUE
Issue Date: 5/22/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
'OFFICE OF THE TOWN CLERK cvFFO(A'
Town of Southold - 3 7
Dli � Application No.
Judith T. Terry, Town Clerk
4'4,;"; .;;.� �l. '/�
$10.00 - Residential d�
Town Hall, 53095 Main Road , , .•
P. O. Box 1179 Er' $25.00 - Non-Residential
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No._ r__
Fee $
DATE .5-7/2 /• `
OWNER NAME: (. e(9? �l�,Pf // l L E5/,,/ 6�' -
OWNER MAILING ADDRESS: l3-4 G 77 ''e- lex (Po
OWNER PROPERTY ADDRESS : eis.s . o e c5 / ire.
71-
OWNER TELEPHONE NUMBER: o,2 � - .4/S'/
TAX MAP NO. : Section ).\) (7 Block Lot /7
CROSS STREET: kr/ C/09- 0(44 _App
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool /7 New Existing
Residential
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.)
, ,e4cte
Siature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
ammilimi,... ,.. .......i...iii
=■
• - - I , - '
i;P, , . ,
iiiiimi - 7 ' ' . . . ' ' - -
NE 1 1 ,
imorm- I (
mom= iii
•.0 • --
•UU NE ■ _
UUU I I ,
NEN NE - •
U. �U
6E1=-■
_UU •
um= - ,I , . :,------.
� lk / ;
U '
111111E ,
IMP= _rJ 14
111111111611111111111111111111111fthi . 1
■■■111-1 / �, :-4 '
, tat ; 111
MIEMBEI IMINE, 1 pm2 e L< i ■ all 3}
IMEMIME - 41e, .EOM
IMIREM, 1=1111118 ,
1111111mmi , . _________,ktaLL. ,JI
Un. - - MSE
1111111111= - 1 INiliiiiiiiimillIll ,
EMIL=MEM IIIIIIIIIIIIIIIMI
■■■
1 NORM
MIN :!:. I_ I 3 r 1
L 1 1 .0 . I ....MO ■
■
I I I 1