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HomeMy WebLinkAboutHarkins 0 ilii JUDITH T.TERRY �" ,A Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 % 41/ Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ® , MARRIAGE OFFICER ���®� �v�®�� Telephone(516) 765-1800 �e/ Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER - ���� FREEDOM OF INFORMATION OFFICER �... .-'1 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3680-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner HARKINS, ROBERT AND BARBARA Mailing Address 1 P. O. BOX 175 Mailing Address 2 City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 270 MOOSE TRAIL Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-7311-7591 Tax Map No. section 103.00 block 4 lot 10.000 Cross Street LITTLE NECK ROAD Issue Date: 9/04/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) • '' !OFFICE OF THE TOWN CLERK �SSFair.''- Town of Southold � CQG Application No.3 8(� Judith T. Terry, Town Clerk Town Hall, 53095 Main Road $10.00 - Residential 4/ P. O. Box 1179 u' z nnArt, 4 i ' �� $25.00 - Non-Residential Southold, New York 11971 O ''' O •�` Telephone of 'P (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ d 11) DATE k1/207JP l� ' 0gyp, k , v OWNER NAME: 4 KJ ,A4s( nct_ (� i- !� 1-2,,,g OWNER MAILING ADDRESS: `U 96077A/ OWNER PROPERTY ADDRESS : 27O 1O _' AZ - ay' ocizo. ,Ici-7-7g;3 OWNER TELEPHONE NUMBER: 03./- 259/ TAX MAP NO. : Section IocFc Lot CROSS STREET: /,/74�(e /(/ /o3v TYPE OF SYSTEM: Septic Tank 11 _New /Existing Cesspool New Existing 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.) Signature of Applican d RECEIVED BY: Town Clerk's Office DATE: 3 oitr '3f3 647 //d, 6(?) • • • • 1' n ..r••elp,•••'Fa.'.(0'i .4 •t • ".,''•�i�y+�lar,�n',���' 'j+.{1, 1 , •t, ip 4 . r• d.' 'r, /� .l:•r i...'1 .,a :. •, s • , ' • •� +. ,1' +..--..t ,- �`'' ' 'i �'#�71 1' I. ,ti.'1P Y^'' ;.*:',::".'4,-, .. i's ''•�, Pr'.-•"-•I'=,rJ,. . .{ • y; M ? 1 • L^S �y 4 • d.} :tit ,'• U, a •. + :; j `#`4dx(• r.. y NL. •1 ►� ,J r 4{ '•.. '�'• ',. . /C, ;t-ti•�:iFi-: .} -'ri•1 ,r.'.►•... iwi�i{�i Wil}i,yrs �-( h S ,i ,. ,n, _/ .fy _ *• '.i`.. - .' „. •�• :'i' • t, t3yriti•�, Ib.: 9�,►Y''' —,1� ., i •;•r• ,•; 7 ff u1 1 _ �1 ' - I 1 T .' 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