HomeMy WebLinkAboutHamlin JUDITH T.TERRY --f;4 Town Hall,53095 Main Road
TOWN CLERK 7°#4, P.O.Box 1179
REGISTRAR OF VITAL STATISTICS = ! Southold,New York 11971
MARRIAGE OFFICER ��I,1� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER � 4 11 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. 3318-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner HAMLIN, THOMAS AND NOREEN
Mailing Address 1 45 BROOKVFIELD AVENUE
Mailing Address 2
City St Zip CENTER MORICHES NY 11934-0000
Property Address 1 KENNY{S ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 000-000-0000
Tax Map No. section 59.00 block 3 lot 18.000
Cross Street MIDDLE ROAD
Issue Date: 4/05/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK c�VFFtC,(- 03��
Town of Southold CQ ' Application No.
Judith T. Terry, Town Clerk ��< `.' 'r �. _
Town Hall, 53095 Main Road 8 .y:=
.G 7 $10.00 - Residential
P. O. Box 1179 u' .. M;'r=•= ` i ; $25.00 - Non-Residential
Southold, New York 11971 O ��
Telephone 14:e?/ , ' "
(516) 765-1801
TOWN OF SOUTHOLD '
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
.- SEPTIC TANK or CESSPOOL '
= Operation Permit No.
Fee $ /0
. DATE 3/3-Ohs)—
OWNER NAME: //-�D(45 t 40;2-F....Eid
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OWNER MAILING ADDRESS: 95' ---&Qpo_._._iEi_. 4e)
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OWNER PROPERTY ADDRESS:: ke-IJIy 'S.50 �T
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OWNER TELEPHONE NUMBER:
• TAX MAP NO. : Section S 7 Block 3 Lot
CROSS STREET: /1/7))(.2E-7 (?-U,Q-) •
1
TYPE OF SYSTEM: Septic Tank )6 New \C Existing
Cesspool New > Existing
• Residential >c Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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 . iplica
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1-h eo /96/
RECEIVED BY:
Town Clerk's Office
DATE: 1/-6----Fa