HomeMy WebLinkAboutHicks oFF014
ELIZABETH A.NEVILLE Is 41/4# %y Town Hall, 53095 Main Road
TOWN CLERK ® -` P.O. Box 1179
rdo Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 471 Fax(516) 765-1823
MARRIAGE OFFICER :� ejs �1
RECORDS MANAGEMENT OFFICER : � ® i Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER = ®� �°s'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3788-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HICKS, MARY JANE
Mailing Address 1 20 HARBOR RIVER ROAD
Mailing Address 2
City St Zip ORIENT NY 11957-0000
Property Address 1 20 HARBOR RIVER ROAD
Property Address 2
City St Zip ORIENT NY 11957-0000
Owner Telephone No. 516-323-2475
Tax Map No. section 24.00 block 1 lot 11 .000
Cross Street SKIPPERS LANE
Issue Date: 5/13/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK �FFO %.\-\
�TOWN OF SOUTHOLD �� �•` Application No. 7 s-
ELIZABETH A.NEVILLE,TOWN CLERK ` ' `:` n'. ' 'a
$10.00 — Residential
P.O.BOX 1179 •
(13 !;t 1. =g4,: ; ` i Z` $25.00 - Non-Residential
SOUTHOLD,NEW YORK 11971 ',t . �.
Telephone ./ * `�
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
--I
DATE - 71
OWNER NAME: / 7 'AAA- '/tcIS
OWNER MAILING ADDRESS: e46 tirtin. go& it I O€, (Li
on ( S7
OWNER PROPERTY ADDRESS: 5 Pri
OWNER TELEPHONE NUMBER: -5 ( (a 'j ).2),
TAX MAP NO. : Section ot ( Block ( Lot l
CROSS STREET: .‘41PILr.il
TYPE OF SYSTEM: Septic Tank New Existing V
Cesspool New Existing V
Residential 17- 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.)
271-4L19,--atte,,
Sjg dature of Applicant
RECEIVED BY: /7A pp
Town Clerk's Office
ADATE: 6 iF,/9
0,41'
.wuna+n r..we..�.»......«....,.�.•.-q..•." -- _- ...•1
, '41.-• .--1 CV ___......../...•
i.
I i� �` • //"rr`
."Illt s
11 r
.......:•y"71.'1 al
• • • \ 1. ..•••••-•
•
VI ` _ + ` r iiii
\ t '.....
''..7...:\t"6 •
•
v
If I
•
ze ,...,
,./ , .
, I 0' - it'l',:.- .';.., •, : . w, •
tb 1 •
.
ti\ ffil
till .
i `y t, r • r r , ` ril
\ .
� � •
y� f4fif t Pr•�45 1 (' « }— .
•
J
't� : ♦ q�} •
• p ••P v i -" ;---'7:' gyp'• ��. . - • 141 ,4..--;; J.4,ft ...,... A, ,. _ .
r • tvJ s
�e1 SOD - „r1 . ter,-•
.0 \ . . kt
o
y�; +� • '
\ . .............._........_ • —• ,
\ . , • //
/,''''.. /