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Home My WebLink AboutHeller osIFFOUr JUT ITH T.TERRY ttt •.# : Town Hall, 53095 Main Road TOWN CLERK % y Z w �'A P.O.Box 1179 �� Southold,New York 11971 REGISTRAR OF VITAL STATISTICS �� Fax(516) 765-1823 y MARRIAGE OFFICER �;* RECORDS MANAGEMENT OFFICER .0010 Telephone Telephone (516) 765-1800 1 FREEDOM OF INFORMATION OFFICER ,is' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 3540-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner HELLER, PECCY/WYDEN, ANNE Mailing Address 1 1145 MAJORS POND ROAD Mailing Address 2 City St Zip ORIENT NY 11957-0000 Property Address 1 2015 BAY AVENUE Property Address 2 City St Zip EAST MARION NY 11939-0000 Owner Telephone No. 516-323-1340 Tax Map No. section 31 .00 block 17 lot 2.000 Cross Street MAIN ROAD Issue Date: 11/06/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) a ... OFFICE OF THE TOWN CLERK ��OFO Town of Southold &,% c. Application No. �� Judith T. Terry, Town Clerk �� .:,;', ..--1%`‘ .e.---"'Town Hall, 53095 Main Road .---;.%,,,;,?, _ $10.00 - Residential P. O. Box 1179 cry ' '° �!" ;- M $25.00 - Non-Residential Southold, New York 11971 O _ O .`. Telephone ' , -Nps, tof (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ /0.. 61) DATE 1 I/q/fh, OWNER NAME: ftJra l _ ei W ( ,,,,f OWNER MAILING ADDRESS: t(L/S 74- -S amb e 6 J i- y- /(qs P __— OWNER PROPERTY ADDRESS: /S' (3 ,/c' 4. r r AN yic3e' OWNER TELEPHONE NUMBER: 32-'3 / 3 '/0 • TAX MAP NO. : Section 3/ Block 1 ? Lot 2— CROSS STREET: Y r ` pj ,j j TYPE,OF SYSTEM:" Septic-Tank "' -.- N'ew 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.) Ctifi2Z T., "la, , e_. .., IR : ure of Applicant RECEIVED BY: _" _ _ Town Clerk's Office DATE:' - _ _ _ _ _ _ _ - - _ "" . _ �/ ��m k�� /ELL6-12_ ' ^ '�� i ��_ tic~ ~~^~^�w_ Iw\ib .-fl . " � �. , . 2 0 1 5 3 A Y AQE . ~ �� 0/2_\ ��°J , �~ . xr ~~ ^ } � 0 LE--.5 . ��/ / �. A��/ -~��mr ~ / ='*~~~ ^- u��-� � |wvlk __.� ' • _ _____ _� ____-_ ___________ ___--__-'-_- �� ' ' ' '~ _____ ) �_�-____ ______ __ -�__ '��__'___ ��_ __�__ � . __-_-__-__ , _______________-_-'_-� __---- _____TH_ itNi\, 1 ,. . . ....._ ._....... _. ......._______________,......__ rv _._11,7 __ , , _ ______ __I, ________ _ _ __.._ 0 ----- \ _ ......____^ _ - __-___ U� --�----- ---�—�---- -�'�---�------- Nn \ | ' Ii1iiIIIii_1Ii !IIIIIiIII1IiiI . _ __�-__- | . - _ ~~~~.� _ _-____-II:___iiII. __- , -' _ , - ----\ /� _ �� 3 1 10 - q ---- /--------- -- ----' ------------' --'-- 01_, ... ...._____________ `'~E.,