HomeMy WebLinkAboutDay, Bob ,a••• vI co
ELIZABETH A. NEVILLE e_� OG'y�; Town Hall, 53095 Main Road
TOWN CLERK O • 11 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER :� l��1�, Fax(631) 765 6145
RECORDS MANAGEMENT OFFICER -'/�lill 'i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ ���� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4144-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner DAY, BOB AND CLAIRE
Mailing Address 1 P 0 BOX 555
Mailing Address 2
City St Zip PECONIC NY 11958-0000
Property Address 1 8055 INDIAN NECK LANE
Property Address 2
City St Zip PECONIC NY 11958-0000
Owner Telephone No. 631-734-7283
Tax Map No. section 86.00 block 6 lot 26.001
Cross Street ROBINSON LANE
. 441._
Issue Date: 5/15/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
0, ss
OFFICE'OF THE TOWN CLERK OC3�FFU(/�`;'
TOWN OF SOUTHOLD �, �G Application No. �,� zy
ELIZABETH A.NEVILLE,TOWN CLERK ' '� j $10.00 - Residential X
P.O.BOX 1179 a
SOUTHOLD,NEW YORK 11971P * •
' /' $25.00 - Non-Residential
Telephone O*0 �O d
. • �
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. Z-4.4 /
Fee $ 10"
DATE l i l t G`((/(• Z2, 1 0'2.
OWNER NAME: 13o6 1- C IA/6,-4_ DtttJ�
OWNER MAILING ADDRESS: 'P. 0 . 6o'( S ,s S
1 cc..0- .t't_. NA(, I t R S $
OWNER PROPERTY ADDRESS: 805 S 4'4,-, ' C-
PCC!- IL. N� ( ( q5r.
OWNER TELEPHONE NUMBER: 63( .3-3(-(• 1-2 $3
TAX MAP NO. : Section U ' l7n Block (2 Lot a G- 0 at
CROSS STREET: a Lou)..... b,,. Lt (-r IR.0(91x15.2, CA,.._.
TYPE OF SYSTEM: Septic Tank X New X Existing
Cesspool )X New /` Existing
Residential X 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.)
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Sign-I re of A. . i a t
RECEIVED BY:
Town Clerk's Office
DATE:
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