HomeMy WebLinkAboutHorne l
4
s 14 CO V
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK •
T P.O. Box 1179
ch ,� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 09 �. ,' Fax (516) 765-1823
MARRIAGE OFFICER `` ® ��
RECORDS MANAGEMENT OFFICER 7® .ya %p ol Telephone (516) 765-1801
T
FREEDOM OF INFORMATION OFFICER ''••����„r,���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3159-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HORNE, ALAN
Mailing Address 1 SOUTH HARBOR ROAD
Mailing Address 2
City St Zip SOUTHOLD NY 11971-0000
Property Address 1 SOUTH HARBOR ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-765-5936
Tax Map No. section 87.00 block 1 lot 14.000
Cross Street HIAWATHA'S PATH
Issue Date: 1/07/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
se
OFFICE OF THE TOWN CLERK c.0FDCA-
Town of SoutholdCQG', Application PNo•_ Slv7
Judith T. Terry, Town Clerk �`; ' isr y 2/
Town Hall, 53095 Main Road ;`; L.< $10.00 - Residential
P. O. Box 1179 cr' ' xj `- ► �` $25.00 - Non-Residential
Southold, New York 11971 �$
Telephone *0( . -01
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
:-.P LlCATIOI': -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. /.5-1'
Fee $ fd"
DATE /410191
OWNER NAME: /Wail rye f
OWNER MAILING ADDRESS: SO J' rthor- .
so c` c_o 1 /. 6/05) .// ,7/
OWNER PROPERTY ADDRESS: ---�j-ocld"( leO(-
5 , cK0h( I/U t /'1 '71
OWNER TELEPHONE NUMBER: 762<-%93lp
TAX MAP NO. : Section 2'7 Block ` Lot /r
,
CROSS STREET: / , LiL , L�;(�
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool v, 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 Applicant
RECEIVED BY: /Y J At-
Town _
Clerk s Office
DATE: / -/c 7/�
l •
•
y /�
T
- C 55 eoo
ksv
I 1 1 . 1 Pct ve+_ -`? I I
so bo
7,1 `,I ,1 16 1 A,I `.1 111 D `ti s 11 • '�` I ' 14 1 ir
sl �'+
4. -"
- 0
Ce.S5 per I ! 5 5-trou Ar/ 01—
fUCL c_or 0 flotkse
! \(
7 I It ill