HomeMy WebLinkAboutMason, Catherine oOS0O4�'0G
ELIZABETH A. NEVILLE ���_ 'yd; Town Hall, 53095 Main Road
TOWN CLERK ; y ; P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS
v, n7 Southold, New York 11971
MARRIAGE OFFICER `\�,fi, l���, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =__-7�1 -1.,„0
r Telephone (631) 765 1800
FREEDOM OF INFORMATION OFFICER ,rsoutholdtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4150-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner MASON, CATHERINE M.
Mailing Address 1 345 HOLDEN AVENUE
Mailing Address 2
City St Zip CUTCHOCUE NY 11935-0000
Property Address 1 345 HOLDEN AVENUE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 631-734-6563
Tax Map No. section 110.00 block 2 lot 13.000
Cross Street DICK'S POINT ROAD
Issue Date: 6/26/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK COFU `;- I=
TOWNOFSOUTHOLD 0�, OG Application No.
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LIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEWYORK 1197144,„ �� $25.00 - Non-Residential
Telephone * Y1��e''
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ /°' pU
DATE J = 2 - 6 Z
OWNER NAME: Ccs - e�� n �. /"l /(-( a 6
OWNER MAILING ADDRESS: 3 �,l /G'I e-A__ d.J
1 GA,_siD C.) /P733
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: 731 5 3
TAX MAP NO. : Section //O , 00 Block 2- Lot / 3 Oo U
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool i/- New Existing
Residential \% Non-Residential
LOCATION MAP: Must be attached ereto before permit may be issued.
-( ocate bui i and system; give north arrow and feet
of distance, app imately, to building and closest road.)
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Signatu e o App icant
LAci I' \it a-el'
RECEIVED BY:
Town Clerk's Office
DATE: