HomeMy WebLinkAboutHughes JUDITH T.TERRY �� y� Town Hall, 53095 Main Road
TOWN CLERK cog P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER A. ®.,11 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER 4714:s.' Telephone(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. 3709-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HUGHES, ARTHUR AND ROSEMARY
Mailing Address 1 BOX 1171
Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
Property Address 1 3165 SOUTH HARBOR ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-298-4472
Tax Map No. section 78.00 block 3 lot 6.000
Cross Street HIAWATHA'S PATH
Issue Date: 10/21/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK 's c§ITFO
Town of Southold , &% , ' Application No. 7��
Judith T. Terry, Town Clerk $10.00 - Residential
Town Hall, 53095 Main Road
P. O. Box 1179 trs i `' $25.00 - Non-Residential
Southold,- New York 11971 OO �O�'�`
Telephone = ,( y
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /Q.
a�
G DATE /Øo/7 ,
OWNER NAME: 441� GE—"'``0' 71
['e
e)A OWNER MAILING ADDRESS: ,o)C 112/
/141-/A YT-e AIY
OWNER PROPERTY ADDRESS: 3/4 �� .9 -t—� /' O��eAOt
SAY l4C.0`
OWNER TELEPHONE NUMBER: 676 2- 7 g-- yy'Z
TAX MAP NO. : Section 07 g Block 3 Lot /V h
CROSS STREET: S41-11ic49-7g--
TYPE OF SYSTEM: Septic.Tank New Existing
Cesspool v dew 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.)
/ 151/
Signature of • .'.licant
RECEIVED BY:
Town Clerk's -Office
DATE: - - -
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