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HomeMy WebLinkAboutHovey ,i,,i �01FF0` ELIZABETH A.NEVILLE is O. ®*A; Town Hall, 53095 Main Road TOWN CLERK ; ® P.O. Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS /Iv Fax (516) 765-1823 MARRIAGE OFFICER � ®�00 Telephone(516) 765-1800 RECORDS MANAGEMENT OFFICER \-74146 411 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. 3762-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner HOVEY (MARELLA), MARY Mailing Address 1 4500 OLE JULE LANE Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 Property Address 1 4500 OLE JULE LANE Property Address 2 City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-298-1059 Tax Map No. section 122.00 block 4 lot 32.000 Cross Street Issue Date: 2/13/98 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) II• OFFICE OF THE TOWN CLERK SIFFO(,r�'- Town of Southold �� +t; CQ ';, Application No.3 7' __ Judith T. Terry, Town Clerk �� r `) $10.00 - Residential Town Hall, 53095 Main Road g _ .^ P. O. Eox 1179 �' _` i `' $25.00 - Non-Residential Southold, New York 11971 Telephone70 K • (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLI CAT ION for OPERATION PERMIT • SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ • DATE -77/_(/7 OWNER NAME: 1/141A-441 t1i 1 � '✓L`=- CC1'� OWNER MAILING ADDRESS: L(�- v-0 dL t J VL(_ OWNER PROPERTY ADDRESS: OWNER TELEPHONE NUMBER: � j 3 / ® JP TAX MAP NO. : Section Block Lot CROSS STREET: TYPE OF SYSTEM: Septic Tank 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.) / ` l Signature of Applicant RECEIVED BY: Town Clerk's Office DATE: 7'0 ( \D,t;3 0