HomeMy WebLinkAboutHanover •
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e rf% Town Hall, 53095 Main Road
�1 <P. O. Box 1179
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Southold, New York 11971
JUDITH T.TERRY 111��K '_ : TELEPHONE
TOWN CLERK ,\`����+• (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3581-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HANOVER, JEANNETTE
Mailing Address 1 P. O. BOX 367
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 180 KERWIN BLVD.
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-8599
Tax Map No. section 53.00 block 2 lot 23.000
Cross Street ROUTE 25
Issue Date: 2/05/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �c�V�FD(,�I'•
Town of Southold , Application No. 3 5--a/Judith T. Terry, Town Clerk
..0 $10.00 - Residential
Town Hall, 53095 Main Road
P. O. Box 1179 U' =+ $25.00 - Non-Residential
Southold, New York 11971 O ` 0�/1`�
Telephone ol �� e.
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE
OWNER NAME: J 2A f7 77 /» ve/
OWNER MAILING ADDRESS: lam. D• Gok 067
ee no // VS7
OWNER PROPERTY ADDRESS: / 0 O /i'e p) / 1/2 6i_vd_
l",c> #064.7-, ..(ay
OWNER TELEPHONE NUMBER: (sr,) L/ 77 - g 9 9
TAX MAP NO. : Section J� Block Lot r�J
CROSS STREET: IR /t
TYPE OF SYSTEM: Septic Tank New Existing X
Cesspool New Existing
Residential >K 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.)
_._.� ,ft / / 2 ti�/i i a.tet
/ Signature of App icant
RECEIVED BY: Z. 42,
Town Clerk's Office
DATE: W3 /? 7
111 d _ ,