HomeMy WebLinkAboutHolmes leor
/II OFFOUr
JUDITH T.TERRY 1t�®� '� Town Hall, 53095 Main Road
TOWN CLERK ` P.O. Box 1179
VCS
i Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ;® � �� Fax(516) 765-1823
MARRIAGE OFFICER • 1* �01
RECORDS MANAGEMENT OFFICER RI �e le" Fax
(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. 3548-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HOLMES, MARIE R.
Mailing Address 1 19 SANDY BEACH ROAD
Mailing Address 2
City St Zip GREENPORT NY 11944-0000
Property Address 1 19 SANDY BEACH ROAD
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-2289
Tax Map No. section 3.00 block 3 lot 9.000
Cross Street BEACH ROAD
Issue Date: 11/15/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK �cOFU1,rl' _ �-�
Town of Southold � * J,. OG Application N 4
Judith T. Terry, Town Clerk .`� 4 ;;
Town Hall, 53095 Main Road 7 $10.00 - Residentialr —
P. O. Box 1179 cn"'„it,;, ?rY ,�` , M `' $25.00 - Non-Residential _
Southold, New York 11971 � ,,'i :;0�
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Telephone ( y1 0
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. -
Fee $
DATE e-n—O-V - q, 79�&
OWNER NAME: G & L
OWNER MAILING ADDRESS: / " I'O_ 44 / ,
�� �1`�` /l 9�
OWNER PROPERTY ADDRESS :
__-_L'_- _J �.- a_GG`--,ed` _ __
q� ( / P C'Cy
OWNER TELEPHONE NUMBER: S/6 - 6/77 2?-Cf9
TAX MAP NO. : Section . ,7--- 3- C Block Lot
CROSS STREET: ce, etd
TYPE OF SYSTEM: Septic Tank New Existing
, Cesspool L.------
New Existing
Residential - 1....------ 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.)
44-e-i-64....e..--&--- .
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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UNAUTHORIZED ALTERATION OR A
f f TO THIS SURVEY IS A VIOLATION
MAP Or Z•. A I-46 6 • SECTION 7209 OF THE NEW YORK
• 1 EDUCATION LAW.
5U Y IZ TEs("E'0 FOR. COPIES OF THIS SURVEY MAP NOT
THE LAND SURVEYOR'S INICD EEA'.
EMBOSSED SCAL SHALL NOT 8E CC
�' ;f . !j , tp /S E I a ++# TO BE A VALID TRUE COPY,
\V/A�� • r;'�'•tl j+ • (" - a '•» �y '" GUARANTEES INDICATED HEREON S
, gyp 11"i1 _ IS PREPARED.,AND ON HIS 131:NALF .
ONLY TO THE PE;SON FOR WHOM
1, �. TITLE COMPANY,GOVERIIY+1,NTAL , '
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, LENDING INSTITUTION LISTED II:FLt
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i( f•�q A'�w '-�I 1'Ci. • - TUTION.GUARANTEES ARE NOT Tb I
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