HomeMy WebLinkAboutHukill (2) JUDITH T. TERRY Town Hall, 53095 Main Road
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TOWN CLERK P.O. Box 1179
6� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = N®' �t' Fax (516) 765-1823
MARRIAGE OFFICER o" Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER = 1 .
FREEDOM OF INFORMATION OFFICER �'�I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3280-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner HUKILL, W. PERRY
Mailing Address 1 12580 MAIN ROAD
Mailing Address 2
City St Zip EAST MARION NY 11939-0000
Property Address 1 12580 MAIN ROA
Property Address 2
City St Zip EAST MARION NY 11939-0000
Owner Telephone No. 516-477-1765
Tax Map No. section 31 .00 block 14 lot 8.001
Cross Street 550' WEST OF DAM POND
Issue Date: 11/15/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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6FFJCE OF,THE TOWN CLERK 5� FO ''-
Town of Southold % C
Judith T. Terry, Town Clerk 4'-,_ . . ; �� Application No. /.gam
Town Hall, 53095 Main Road a , , • , f< $10.00 - Residential ✓
P. O. Box 1179 urs -• • ' i z' $25_.00 - Non-Residential
Southold, New York 11971 Obi 0����� ._
Telephone Oj * * • o'
(5 6) 765-1801 ;,D
TOWN OF SOUTHOLD L.O'V 1 • 1994
Sops"
SOUTHOLD WASTEWATER DISPOSAL DISTRICTold df`o •
o Cierk
APPLICATION
for
V.),,t,01")..)
OPERATION PERMIT
•
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE
•
OWNER NAME: 4 s PL RAX HU�K (L L
f
OWNER MAILING ADDRESS: / 7is�O /IA/n/ ED/? D
---71,5 r /74 2r04r, N y. //939
OWNER PROPERTY ADDRESS: S /)//t
OWNER TELEPHONE NUMBER: .5-16 ' Z"77 r / 431-
TAX MAP NO. : Section 3 / Block P4 Lot R''r
CROSS STREET: '± 7 4 -- i - i2E/z&, s1 /// gov
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New Existing
Residential ; .4.9 Non-Residential
• I
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.)
.4a° '7,-/e-rIZCZe
Signa re of Applicant
RECEIVED BY: �e-'1
/ Town Clerk's Office
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DATE: ( 1 1L
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